Biologically derived extracellular matrix with infused viscous absorbable copolymer for releasably attaching a staple buttress to a surgical stapler

ABSTRACT

A surgical stapler end effector comprises a staple cartridge, an anvil, and a buttress assembly. The staple cartridge comprises a plurality of staples and a deck. The staple cartridge is operable to drive the staples through the deck. The anvil is movable from an open position toward the staple cartridge to reach a closed position. The anvil includes an underside having staple forming surface configured to receive staples driven through the deck. The buttress assembly comprises a buttress body and an adhesive material. The buttress body defines a plurality of cells. The adhesive material comprises a polymer. The polymer is bioabsorbable. A first portion of the adhesive material is located within cells of the plurality of cells. A second portion of the adhesive material is located on the buttress body outside the plurality of cells.

BACKGROUND

In some settings, endoscopic surgical instruments may be preferred overtraditional open surgical devices since a smaller incision may reducethe post-operative recovery time and complications. Consequently, someendoscopic surgical instruments may be suitable for placement of adistal end effector at a desired surgical site through the cannula of atrocar. These distal end effectors may engage tissue in a number of waysto achieve a diagnostic or therapeutic effect (e.g., endocutter,grasper, cutter, stapler, clip applier, access device, drug/gene therapydelivery device, and energy delivery device using ultrasonic vibration,RF, laser, etc.). Endoscopic surgical instruments may include a shaftbetween the end effector and a handle portion, which is manipulated bythe clinician. Such a shaft may enable insertion to a desired depth androtation about the longitudinal axis of the shaft, thereby facilitatingpositioning of the end effector within the patient. Positioning of anend effector may be further facilitated through inclusion of one or morearticulation joints or features, enabling the end effector to beselectively articulated or otherwise deflected relative to thelongitudinal axis of the shaft.

Examples of endoscopic surgical instruments include surgical staplers.Some such staplers are operable to clamp down on layers of tissue, cutthrough the clamped layers of tissue, and drive staples through thelayers of tissue to substantially seal the severed layers of tissuetogether near the severed ends of the tissue layers. Merely exemplarysurgical staplers are disclosed in U.S. Pat. No. 4,805,823, entitled“Pocket Configuration for Internal Organ Staplers,” issued Feb. 21,1989; U.S. Pat. No. 5,415,334, entitled “Surgical Stapler and StapleCartridge,” issued May 16, 1995; U.S. Pat. No. 5,465,895, entitled“Surgical Stapler Instrument,” issued Nov. 14, 1995; U.S. Pat. No.5,597,107, entitled “Surgical Stapler Instrument,” issued Jan. 28, 1997;U.S. Pat. No. 5,632,432, entitled “Surgical Instrument,” issued May 27,1997; U.S. Pat. No. 5,673,840, entitled “Surgical Instrument,” issuedOct. 7, 1997; U.S. Pat. No. 5,704,534, entitled “Articulation Assemblyfor Surgical Instruments,” issued Jan. 6, 1998; U.S. Pat. No. 5,814,055,entitled “Surgical Clamping Mechanism,” issued Sep. 29, 1998; U.S. Pat.No. 6,978,921, entitled “Surgical Stapling Instrument Incorporating anE-Beam Firing Mechanism,” issued Dec. 27, 2005; U.S. Pat. No. 7,000,818,entitled “Surgical Stapling Instrument Having Separate Distinct Closingand Firing Systems,” issued Feb. 21, 2006; U.S. Pat. No. 7,143,923,entitled “Surgical Stapling Instrument Having a Firing Lockout for anUnclosed Anvil,” issued Dec. 5, 2006; U.S. Pat. No. 7,303,108, entitled“Surgical Stapling Instrument Incorporating a Multi-Stroke FiringMechanism with a Flexible Rack,” issued Dec. 4, 2007; U.S. Pat. No.7,367,485, entitled “Surgical Stapling Instrument Incorporating aMultistroke Firing Mechanism Having a Rotary Transmission,” issued May6, 2008; U.S. Pat. No. 7,380,695, entitled “Surgical Stapling InstrumentHaving a Single Lockout Mechanism for Prevention of Firing,” issued Jun.3, 2008; U.S. Pat. No. 7,380,696, entitled “Articulating SurgicalStapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism,”issued Jun. 3, 2008; U.S. Pat. No. 7,404,508, entitled “SurgicalStapling and Cutting Device,” issued Jul. 29, 2008; U.S. Pat. No.7,434,715, entitled “Surgical Stapling Instrument Having MultistrokeFiring with Opening Lockout,” issued Oct. 14, 2008; U.S. Pat. No.7,721,930, entitled “Disposable Cartridge with Adhesive for Use with aStapling Device,” issued May 25, 2010; U.S. Pat. No. 8,408,439, entitled“Surgical Stapling Instrument with An Articulatable End Effector,”issued Apr. 2, 2013; and U.S. Pat. No. 8,453,914, entitled “Motor-DrivenSurgical Cutting Instrument with Electric Actuator Directional ControlAssembly,” issued Jun. 4, 2013. The disclosure of each of theabove-cited U.S. Patents is incorporated by reference herein.

While the surgical staplers referred to above are described as beingused in endoscopic procedures, it should be understood that suchsurgical staplers may also be used in open procedures and/or othernon-endoscopic procedures. By way of example only, a surgical staplermay be inserted through a thoracotomy, and thereby between a patient'sribs, to reach one or more organs in a thoracic surgical procedure thatdoes not use a trocar as a conduit for the stapler. Such procedures mayinclude the use of the stapler to sever and close a vessel leading to alung. For instance, the vessels leading to an organ may be severed andclosed by a stapler before removal of the organ from the thoraciccavity. Of course, surgical staplers may be used in various othersettings and procedures.

Examples of surgical staplers that may be particularly suited or usethrough a thoracotomy are disclosed in U.S. Patent Pub. No.2014/0243801, entitled “Surgical Instrument End Effector ArticulationDrive with Pinion and Opposing Racks,” published Aug. 28, 2014, issuedas U.S. Pat. No. 9,186,142 on Nov. 17, 2015; U.S. Patent Pub. No.2014/0239041, entitled “Lockout Feature for Movable Cutting Member ofSurgical Instrument,” published Aug. 28, 2014, issued as U.S. Pat. No.9,717,497 on Aug. 1, 2016; U.S. Patent Pub. No. 2014/0239042, entitled“Integrated Tissue Positioning and Jaw Alignment Features for SurgicalStapler,” published Aug. 28, 2014, issued as U.S. Pat. No. 9,517,065 onDec. 13, 2016; U.S. Patent Pub. No. 2014/0239036, entitled “Jaw ClosureFeature for End Effector of Surgical Instrument,” published Aug. 28,2014, issued as U.S. Pat. No. 9,839,421 on Dec. 12, 2017; U.S. PatentPub. No. 2014/0239040, entitled “Surgical Instrument with ArticulationLock having a Detenting Binary Spring,” published Aug. 28, 2014, issuedas U.S. Pat. No. 9,867,615 on Jan. 16, 2018; U.S. Patent Pub. No.2014/0239043, entitled “Distal Tip Features for End Effector of SurgicalInstrument,” published Aug. 28, 2014, issued as U.S. Pat. No. 9,622,746on Apr. 18, 2017; U.S. Patent Pub. No. 2014/0239037, entitled “StapleForming Features for Surgical Stapling Instrument,” published Aug. 28,2014, issued as U.S. Pat. No. 10,092,292 on Oct. 9, 2018; U.S. PatentPub. No. 2014/0239038, entitled “Surgical Instrument with Multi-DiameterShaft,” published Aug. 28, 2014, issued as U.S. Pat. No. 9,795,379 onOct. 24, 2017; and U.S. Patent Pub. No. 2014/0239044, entitled“Installation Features for Surgical Instrument End Effector Cartridge,”published Aug. 28, 2014, issued as U.S. Pat. No. 9,808,248 on Nov. 7,2017. The disclosure of each of the above-cited U.S. Patent Publicationsis incorporated by reference herein.

Additional surgical stapling instruments are disclosed in U.S. Pat. No.8,141,762, entitled “Surgical Stapler Comprising a Staple Pocket,”issued Mar. 27, 2012; U.S. Pat. No. 8,371,491, entitled “Surgical EndEffector Having Buttress Retention Features,” issued Feb. 12, 2013; U.S.Pub. No. 2014/0263563, entitled “Method and Apparatus for SealingEnd-to-End Anastomosis” published Sep. 18, 2014, issued as U.S. Pat. No.9,597,082 on Mar. 21, 2017; U.S. Pub. No. 2014/0246473, entitled “RotaryPowered Surgical Instruments with Multiple Degrees of Freedom,”published Sep. 4, 2014, issued as U.S. Pat. No. 9,398,911 on Jul. 26,2016; U.S. Pub. No. 2013/0206813, entitled “Linear Stapler,” publishedAug. 15, 2013, now abandoned; U.S. Pub. No. 2008/0169328, entitled“Buttress Material for Use with a Surgical Stapler,” published Jul. 17,2008, now abandoned; U.S. patent application Ser. No. 14/300,804,entitled “Woven and Fibrous Materials for Reinforcing a Staple Line,”filed Jun. 10, 2014, issued as U.S. Pat. No. 9,848,871 on Dec. 26, 2017;U.S. patent application Ser. No. 14/300,811, entitled “Devices andMethods for Sealing Staples in Tissue”, issued as U.S. Pat. No.9,936,954 on Apr. 10, 2018; and U.S. patent application Ser. No.14/498,070, entitled “Radically Expandable Staple Line” filed Sep. 26,2014, published as U.S. Pub. No. 2016/0089146 on Mar. 31, 2016. Thedisclosure of each of the above-cited U.S. Patents, U.S. PatentPublications, and U.S. Patent Applications is incorporated by referenceherein.

In some instances, it may be desirable to equip a surgical staplinginstrument with a buttress material to reinforce the mechanicalfastening of tissue provided by staples. Such a buttress may prevent theapplied staples from pulling through tissue and may otherwise reduce arisk of tissue tearing at or near the site of applied staples.

While various kinds of surgical stapling instruments and associatedcomponents have been made and used, it is believed that no one prior tothe inventor(s) has made or used the invention described in the appendedclaims.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the invention,and, together with the general description of the invention given above,and the detailed description of the embodiments given below, serve toexplain the principles of the present invention.

FIG. 1 depicts a perspective view of an exemplary articulating surgicalstapling instrument;

FIG. 2 depicts a side elevational view of the instrument of FIG. 1;

FIG. 3 depicts a perspective view of an end effector of the instrumentof FIG. 1, with the end effector in a closed configuration;

FIG. 4 depicts a perspective view of the end effector of FIG. 3, withthe end effector in an open configuration;

FIG. 5 depicts an exploded perspective view of the end effector of FIG.3;

FIG. 6 depicts a cross-sectional end view of the end effector of FIG. 3,taken along line 6-6 of FIG. 4;

FIG. 7A depicts a cross-sectional side view of the end effector of FIG.3, taken along line 7-7 of FIG. 4, with a firing beam in a proximalposition;

FIG. 7B depicts a cross-sectional side view of the end effector of FIG.3, taken along line 7-7 of FIG. 4, with the firing beam in a distalposition;

FIG. 8 depicts a perspective view of the end effector of FIG. 3,positioned at tissue and having been actuated once in the tissue;

FIG. 9 depicts a cross-sectional view of an exemplary buttress assemblythat may be used with the end effector of FIG. 3;

FIG. 10 depicts an exploded perspective view of an exemplary buttressand retainer;

FIG. 11 depicts a perspective view of the buttress and retainer of FIG.10, with the buttress secured to the underside of the retainer;

FIG. 12A depicts a side elevational view of the buttress and retainer ofFIG. 10 positioned for engagement with the end effector of FIG. 3;

FIG. 12B depicts a side elevational view of the buttress and retainer ofFIG. 10 engaging the end effector of FIG. 3, with the anvil of the endeffector in an open position;

FIG. 12C depicts a side elevational view of the buttress and retainer ofFIG. 10 engaging the end effector of FIG. 3, with the anvil of the endeffector moving toward a closed position;

FIG. 12D depicts a side elevational view of the retainer of FIG. 10being moved away from the end effector of FIG. 3, with the buttress ofFIG. 10 being left behind on the end effector to form an end effectorand buttress assembly;

FIG. 13A depicts a cross-sectional view of a portion of the end effectorand buttress assembly of FIG. 12D, with tissue positioned between thebuttress and the anvil, and with the anvil in an open position;

FIG. 13B depicts a cross-sectional view of a portion of the end effectorand buttress assembly of FIG. 12D, with tissue positioned between thebuttress and the anvil, and with the anvil in a closed position;

FIG. 13C depicts a cross-sectional view of a staple and the buttress ofFIG. 12D being secured to tissue by the end effector of FIG. 12D;

FIG. 14 depicts a perspective view of staples and the buttress of FIG.12D having been secured to tissue by the end effector of FIG. 12D;

FIG. 15 depicts an exploded perspective view of an exemplary buttressand retainer;

FIG. 16 depicts a perspective view of the buttress and retainer of FIG.15, with the buttress secured to the top side of the retainer;

FIG. 17A depicts a side elevational view of the buttress and retainer ofFIG. 15 positioned for engagement with the end effector of FIG. 3;

FIG. 17B depicts a side elevational view of the retainer of FIG. 15being moved away from the end effector of FIG. 3, with the buttress ofFIG. 15 being left behind on the end effector to form an end effectorand buttress assembly;

FIG. 18A depicts a cross-sectional view of a portion of the end effectorand buttress assembly of FIG. 17B, with tissue positioned between thebuttress and the staple cartridge, and with the anvil in an openposition;

FIG. 18B depicts a cross-sectional view of a portion of the end effectorand buttress assembly of FIG. 17B, with tissue positioned between thebuttress and the staple cartridge, and with the anvil in a closedposition;

FIG. 18C depicts a cross-sectional view of a staple and the buttress ofFIG. 17B being secured to tissue by the end effector of FIG. 17B;

FIG. 19 depicts a perspective view of staples and the buttress of FIG.17B having been secured to tissue by the end effector of FIG. 17B;

FIG. 20 depicts a perspective view of another exemplary alternativebuttress assembly;

FIG. 21 depicts a cross-sectional view of a region of the buttressassembly of FIG. 20;

FIG. 22 depicts a cross-sectional view of a region of the buttressassembly of FIG. 20 being compressed against the anvil of the endeffector of FIG. 3;

FIG. 23 depicts a perspective view of an exemplary alternative retainer;and

FIG. 24 depicts an exploded cross-sectional view of an exemplarybuttress assembly between an exemplary retainer and the anvil of the endeffector of FIG. 3.

The drawings are not intended to be limiting in any way, and it iscontemplated that various embodiments of the invention may be carriedout in a variety of other ways, including those not necessarily depictedin the drawings. The accompanying drawings incorporated in and forming apart of the specification illustrate several aspects of the presentinvention, and together with the description serve to explain theprinciples of the invention; it being understood, however, that thisinvention is not limited to the precise arrangements shown.

DETAILED DESCRIPTION

The following description of certain examples of the invention shouldnot be used to limit the scope of the present invention. Other examples,features, aspects, embodiments, and advantages of the invention willbecome apparent to those skilled in the art from the followingdescription, which is by way of illustration, one of the best modescontemplated for carrying out the invention. As will be realized, theinvention is capable of other different and obvious aspects, all withoutdeparting from the invention. Accordingly, the drawings and descriptionsshould be regarded as illustrative in nature and not restrictive.

I. Exemplary Surgical Stapler

FIG. 1 depicts an exemplary surgical stapling and severing instrument(10) that includes a handle assembly (20), a shaft assembly (30), and anend effector (40). End effector (40) and the distal portion of shaftassembly (30) are sized for insertion, in a nonarticulated state asdepicted in FIG. 1, through a trocar cannula to a surgical site in apatient for performing a surgical procedure. By way of example only,such a trocar may be inserted in a patient's abdomen, between two of thepatient's ribs, or elsewhere. In some settings, instrument (10) is usedwithout a trocar. For instance, end effector (40) and the distal portionof shaft assembly (30) may be inserted directly through a thoracotomy orother type of incision. It should be understood that terms such as“proximal” and “distal” are used herein with reference to a cliniciangripping handle assembly (20) of instrument (10). Thus, end effector(40) is distal with respect to the more proximal handle assembly (20).It will be further appreciated that for convenience and clarity, spatialterms such as “vertical” and “horizontal” are used herein with respectto the drawings. However, surgical instruments are used in manyorientations and positions, and these terms are not intended to belimiting and absolute.

A. Exemplary Handle Assembly and Shaft Assembly

As shown in FIGS. 1-2, handle assembly (20) of the present examplecomprises pistol grip (22), a closure trigger (24), and a firing trigger(26). Each trigger (24, 26) is selectively pivotable toward and awayfrom pistol grip (22) as will be described in greater detail below.Handle assembly (20) further includes an anvil release button (25), afiring beam reverse switch (27), and a removable battery pack (28).These components will also be described in greater detail below. Ofcourse, handle assembly (20) may have a variety of other components,features, and operabilities, in addition to or in lieu of any of thosenoted above. Other suitable configurations for handle assembly (20) willbe apparent to those of ordinary skill in the art in view of theteachings herein.

As shown in FIGS. 1-3, shaft assembly (30) of the present examplecomprises an outer closure tube (32), an articulation section (34), anda closure ring (36), which is further coupled with end effector (40).Closure tube (32) extends along the length of shaft assembly (30).Closure ring (36) is positioned distal to articulation section (34).Closure tube (32) and closure ring (36) are configured to translatelongitudinally relative to handle assembly (20). Longitudinaltranslation of closure tube (32) is communicated to closure ring (36)via articulation section (34). Exemplary features that may be used toprovide longitudinal translation of closure tube (32) and closure ring(36) will be described in greater detail below.

Articulation section (34) is operable to laterally deflect closure ring(36) and end effector (40) laterally away from the longitudinal axis(LA) of shaft assembly (30) at a desired angle (a). End effector (40)may thereby reach behind an organ or approach tissue from a desiredangle or for other reasons. In some versions, articulation section (34)enables deflection of end effector (40) along a single plane. In someother versions, articulation section (34) enables deflection of endeffector along more than one plane. In the present example, articulationis controlled through an articulation control knob (35) which is locatedat the proximal end of shaft assembly (30). Knob (35) is rotatable aboutan axis that is perpendicular to the longitudinal axis (LA) of shaftassembly (30). Closure ring (36) and end effector (40) pivot about anaxis that is perpendicular to the longitudinal axis (LA) of shaftassembly (30) in response to rotation of knob (35). By way of exampleonly, rotation of knob (35) clockwise may cause corresponding clockwisepivoting of closure ring (36) and end effector (40) at articulationsection (34). Articulation section (34) is configured to communicatelongitudinal translation of closure tube (32) to closure ring (36),regardless of whether articulation section (34) is in a straightconfiguration or an articulated configuration.

In some versions, articulation section (34) and/or articulation controlknob (35) are/is constructed and operable in accordance with at leastsome of the teachings of U.S. Pub. No. 2014/0243801, entitled “SurgicalInstrument End Effector Articulation Drive with Pinion and OpposingRacks,” published Aug. 28, 2014, issued as U.S. Pat. No. 9,186,142 onNov. 17, 2015, the disclosure of which is incorporated by referenceherein. Articulation section (34) may also be constructed and operablein accordance with at least some of the teachings of U.S. patentapplication Ser. No. 14/314,125, entitled “Articulation Drive Featuresfor Surgical Stapler,” filed Jun. 25, 2014, issued as U.S. Pat. No.10,292,701 on May 21, 2019, the disclosure of which is incorporated byreference herein; and/or in accordance with the various teachings below.Other suitable forms that articulation section (34) and articulationknob (35) may take will be apparent to those of ordinary skill in theart in view of the teachings herein.

As shown in FIGS. 1-2, shaft assembly (30) of the present examplefurther includes a rotation knob (31). Rotation knob (31) is operable torotate the entire shaft assembly (30) and end effector (40) relative tohandle assembly (20) about the longitudinal axis (LA) of shaft assembly(30). In some versions, rotation knob (31) is operable to selectivelylock the angular position of shaft assembly (30) and end effector (40)relative to handle assembly (20) about the longitudinal axis (LA) ofshaft assembly (30). For instance, rotation knob (31) may betranslatable between a first longitudinal position, in which shaftassembly (30) and end effector (40) are rotatable relative to handleassembly (20) about the longitudinal axis (LA) of shaft assembly (30);and a second longitudinal position, in which shaft assembly (30) and endeffector (40) are not rotatable relative to handle assembly (20) aboutthe longitudinal axis (LA) of shaft assembly (30). Of course, shaftassembly (30) may have a variety of other components, features, andoperabilities, in addition to or in lieu of any of those noted above. Byway of example only, at least part of shaft assembly (30) is constructedin accordance with at least some of the teachings of U.S. Pub. No.2014/0239038, entitled “Surgical Instrument with Multi-Diameter Shaft,”published Aug. 28, 2014, issued as U.S. Pat. No. 9,795,379 on Oct. 24,2017, the disclosure of which is incorporated by reference herein. Othersuitable configurations for shaft assembly (30) will be apparent tothose of ordinary skill in the art in view of the teachings herein.

B. Exemplary End Effector

As also shown in FIGS. 1-3, end effector (40) of the present exampleincludes a lower jaw (50) and a pivotable anvil (60). Anvil (60)includes a pair of integral, outwardly extending pins (66) that aredisposed in corresponding curved slots (54) of lower jaw (50). Pins (66)and slots (54) are shown in FIG. 5. Anvil (60) is pivotable toward andaway from lower jaw (50) between an open position (shown in FIGS. 2 and4) and a closed position (shown in FIGS. 1, 3, and 7A-7B). Use of theterm “pivotable” (and similar terms with “pivot” as a base) should notbe read as necessarily requiring pivotal movement about a fixed axis.For instance, in the present example, anvil (60) pivots about an axisthat is defined by pins (66), which slide along curved slots (54) oflower jaw (50) as anvil (60) moves toward lower jaw (50). In suchversions, the pivot axis translates along the path defined by slots (54)while anvil (60) simultaneously pivots about that axis. In addition orin the alternative, the pivot axis may slide along slots (54) first,with anvil (60) then pivoting about the pivot axis after the pivot axishas slid a certain distance along the slots (54). It should beunderstood that such sliding/translating pivotal movement is encompassedwithin terms such as “pivot,” “pivots,” “pivotal,” “pivotable,”“pivoting,” and the like. Of course, some versions may provide pivotalmovement of anvil (60) about an axis that remains fixed and does nottranslate within a slot or channel, etc.

As best seen in FIG. 5, lower jaw (50) of the present example defines achannel (52) that is configured to receive a staple cartridge (70).Staple cartridge (70) may be inserted into channel (52), end effector(40) may be actuated, and then staple cartridge (70) may be removed andreplaced with another staple cartridge (70). Lower jaw (50) thusreleasably retains staple cartridge (70) in alignment with anvil (60)for actuation of end effector (40). In some versions, lower jaw (50) isconstructed in accordance with at least some of the teachings of U.S.Pub. No. 2014/0239044, entitled “Installation Features for SurgicalInstrument End Effector Cartridge,” published Aug. 28, 2014, issued asU.S. Pat. No. 9,808,248 on Nov. 7, 2017, the disclosure of which isincorporated by reference herein. Other suitable forms that lower jaw(50) may take will be apparent to those of ordinary skill in the art inview of the teachings herein.

As best seen in FIGS. 4-6, staple cartridge (70) of the present examplecomprises a cartridge body (71) and a tray (76) secured to the undersideof cartridge body (71). The upper side of cartridge body (71) presents adeck (73), against which tissue may be compressed when anvil (60) is ina closed position. Cartridge body (71) further defines a longitudinallyextending channel (72) and a plurality of staple pockets (74). A staple(77) is positioned in each staple pocket (74). A staple driver (75) isalso positioned in each staple pocket (74), underneath a correspondingstaple (77), and above tray (76). As will be described in greater detailbelow, staple drivers (75) are operable to translate upwardly in staplepockets (74) to thereby drive staples (77) upwardly through staplepockets (74) and into engagement with anvil (60). Staple drivers (75)are driven upwardly by a wedge sled (78), which is captured betweencartridge body (71) and tray (76), and which translates longitudinallythrough cartridge body (71). Wedge sled (78) includes a pair ofobliquely angled cam surfaces (79), which are configured to engagestaple drivers (75) and thereby drive staple drivers (75) upwardly aswedge sled (78) translates longitudinally through cartridge (70). Forinstance, when wedge sled (78) is in a proximal position as shown inFIG. 7A, staple drivers (75) are in downward positions and staples (77)are located in staple pockets (74). As wedge sled (78) is driven to thedistal position shown in FIG. 7B by a translating knife member (80),wedge sled (78) drives staple drivers (75) upwardly, thereby drivingstaples (77) out of staple pockets (74) and into staple forming pockets(64) that are formed in the underside (65) of anvil (60). Thus, stapledrivers (75) translate along a vertical dimension as wedge sled (78)translates along a horizontal dimension.

It should be understood that the configuration of staple cartridge (70)may be varied in numerous ways. For instance, staple cartridge (70) ofthe present example includes two longitudinally extending rows of staplepockets (74) on one side of channel (72); and another set of twolongitudinally extending rows of staple pockets (74) on the other sideof channel (72). However, in some other versions, staple cartridge (70)includes three, one, or some other number of staple pockets (74) on eachside of channel (72). In some versions, staple cartridge (70) isconstructed and operable in accordance with at least some of theteachings of U. U.S. patent application Ser. No. 13/780,106, entitled“Integrated Tissue Positioning and Jaw Alignment Features for SurgicalStapler,” filed Feb. 28, 2013, issued as U.S. Pat. No. 9,517,065 on Dec.13, 2016, the disclosure of which is incorporated by reference herein.In addition or in the alternative, staple cartridge (70) may beconstructed and operable in accordance with at least some of theteachings of U.S. Pub. No. 2014/0239044, entitled “Installation Featuresfor Surgical Instrument End Effector Cartridge,” published Aug. 28,2014, issued as U.S. Pat. No. 9,808,248 on Nov. 7, 2017, the disclosureof which is incorporated by reference herein. Other suitable forms thatstaple cartridge (70) may take will be apparent to those of ordinaryskill in the art in view of the teachings herein.

As best seen in FIG. 4, anvil (60) of the present example comprises alongitudinally extending channel (62) and a plurality of staple formingpockets (64). Channel (62) is configured to align with channel (72) ofstaple cartridge (70) when anvil (60) is in a closed position. Eachstaple forming pocket (64) is positioned to lie over a correspondingstaple pocket (74) of staple cartridge (70) when anvil (60) is in aclosed position. Staple forming pockets (64) are configured to deformthe legs of staples (77) when staples (77) are driven through tissue andinto anvil (60). In particular, staple forming pockets (64) areconfigured to bend the legs of staples (77) to secure the formed staples(77) in the tissue. Anvil (60) may be constructed in accordance with atleast some of the teachings of U.S. Pub. No. 2014/0239042, entitled“Integrated Tissue Positioning and Jaw Alignment Features for SurgicalStapler,” published Aug. 28, 2014, issued as U.S. Pat. No. 9,517,065 onDec. 13, 2016; at least some of the teachings of U.S. Pub. No.2014/0239036, entitled “Jaw Closure Feature for End Effector of SurgicalInstrument,” published Aug. 28, 2014, issued as U.S. Pat. No. 9,839,421on Dec. 12, 2017; and/or at least some of the teachings of U.S. Pub. No.2014/0239037, entitled “Staple Forming Features for Surgical StaplingInstrument,” published Aug. 28, 2014, issued as U.S. Pat. No. 10,092,292on Oct. 9, 2018, the disclosure of which is incorporated by referenceherein. Other suitable forms that anvil (60) may take will be apparentto those of ordinary skill in the art in view of the teachings herein.

In the present example, a knife member (80) is configured to translatethrough end effector (40). As best seen in FIGS. 5 and 7A-7B, knifemember (80) is secured to the distal end of a firing beam (82), whichextends through a portion of shaft assembly (30). As best seen in FIGS.4 and 6, knife member (80) is positioned in channels (62, 72) of anvil(60) and staple cartridge (70). Knife member (80) includes a distallypresented cutting edge (84) that is configured to sever tissue that iscompressed between anvil (60) and deck (73) of staple cartridge (70) asknife member (80) translates distally through end effector (40). Asnoted above and as shown in FIGS. 7A-7B, knife member (80) also driveswedge sled (78) distally as knife member (80) translates distallythrough end effector (40), thereby driving staples (77) through tissueand against anvil (60) into formation. Various features that may be usedto drive knife member (80) distally through end effector (40) will bedescribed in greater detail below.

In some versions, end effector (40) includes lockout features that areconfigured to prevent knife member (80) from advancing distally throughend effector (40) when a staple cartridge (70) is not inserted in lowerjaw (50). In addition or in the alternative, end effector (40) mayinclude lockout features that are configured to prevent knife member(80) from advancing distally through end effector (40) when a staplecartridge (70) that has already been actuated once (e.g., with allstaples (77) deployed therefrom) is inserted in lower jaw (50). By wayof example only, such lockout features may be configured in accordancewith at least some of the teachings of U.S. Pub. No. 2014/0239041,entitled “Lockout Feature for Movable Cutting Member of SurgicalInstrument,” published Aug. 28, 2014, issued as U.S. Pat. No. 9,717,497on Aug. 1, 2017, the disclosure of which is incorporated by referenceherein; and/or at least some of the teachings of U.S. patent applicationSer. No. 14/314,108, entitled “Method of Using Lockout Features forSurgical Stapler Cartridge,” filed on Jun. 25, 2014, issued as U.S. Pat.No. 10,335,147 on Jul. 2, 2019, the disclosure of which is incorporatedby reference herein. Other suitable forms that lockout features may takewill be apparent to those of ordinary skill in the art in view of theteachings herein. Alternatively, end effector (40) may simply omit suchlockout features.

C. Exemplary Actuation of Anvil

In the present example, anvil (60) is driven toward lower jaw (50) byadvancing closure ring (36) distally relative to end effector (40).Closure ring (36) cooperates with anvil (60) through a camming action todrive anvil (60) toward lower jaw (50) in response to distal translationof closure ring (36) relative to end effector (40). Similarly, closurering (36) may cooperate with anvil (60) to open anvil (60) away fromlower jaw (50) in response to proximal translation of closure ring (36)relative to end effector (40). By way of example only, closure ring (36)and anvil (60) may interact in accordance with at least some of theteachings of U.S. Pub. No. 2014/0239036, entitled “Jaw Closure Featurefor End Effector of Surgical Instrument,” published Aug. 28, 2014,issued as U.S. Pat. No. 9,839,421 on Dec. 12, 2017, the disclosure ofwhich is incorporated by reference herein; and/or in accordance with atleast some of the teachings of U.S. patent application Ser. No.14/314,108, entitled “Jaw Opening Feature for Surgical Stapler,” filedon Jun. 25, 2014, published as U.S. Pub. No. 2015/0374373 on Dec. 31,2015, the disclosure of which is incorporated by reference herein.Exemplary features that may be used to provide longitudinal translationof closure ring (36) relative to end effector (40) will be described ingreater detail below.

As noted above, handle assembly (20) includes a pistol grip (22) and aclosure trigger (24). As also noted above, anvil (60) is closed towardlower jaw (50) in response to distal advancement of closure ring (36).In the present example, closure trigger (24) is pivotable toward pistolgrip (22) to drive closure tube (32) and closure ring (36) distally.Various suitable components that may be used to convert pivotal movementof closure trigger (24) toward pistol grip (22) into distal translationof closure tube (32) and closure ring (36) relative to handle assembly(20) will be apparent to those of ordinary skill in the art in view ofthe teachings herein. When closure trigger (24) reaches a fully pivotedstate, such that anvil (60) is in a fully closed position relative tolower jaw (50), locking features in handle assembly (20) lock theposition of trigger (24) and closure tube (32), thereby locking anvil(60) in a fully closed position relative to lower jaw (50). Theselocking features are released by actuation of anvil release button (25).Anvil release button (25) is configured and positioned to be actuated bythe thumb of the operator hand that grasps pistol grip (22). In otherwords, the operator may grasp pistol grip (22) with one hand, actuateclosure trigger (24) with one or more fingers of the same hand, and thenactuate anvil release button (25) with the thumb of the same hand,without ever needing to release the grasp of pistol grip (22) with thesame hand. Other suitable features that may be used to actuate anvil(60) will be apparent to those of ordinary skill in the art in view ofthe teachings herein.

D. Exemplary Actuation of Firing Beam

In the present example, instrument (10) provides motorized control offiring beam (82). In particular, instrument (10) includes motorizedcomponents that are configured to drive firing beam (82) distally inresponse to pivoting of firing trigger (26) toward pistol grip (22). Insome versions, a motor (not shown) is contained in pistol grip (22) andreceives power from battery pack (28). This motor is coupled with atransmission assembly (not shown) that converts rotary motion of a driveshaft of the motor into linear translation of firing beam (82). In somesuch versions, firing beam (82) may only be advanced distally when anvil(60) is in a fully closed position relative to lower jaw (50). Afterfiring beam (82) is advanced distally to sever tissue and drive staples(77) as described above with reference to FIGS. 7A-7B, the driveassembly for firing beam (82) may be automatically reversed to drivefiring beam (82) proximally back to the retracted position (e.g., backfrom the position shown in FIG. 7B to the position shown in FIG. 7A).Alternatively, the operator may actuate firing beam reverse switch (27),which may reverse the drive assembly for firing beam (82) in order toretract firing beam (82) to a proximal position. Handle assembly (20) ofthe present example further includes a bailout feature (21), which isoperable to provide a mechanical bailout allowing the operator tomanually retract firing beam (82) proximally (e.g., in the event ofpower loss while firing beam (82) is in a distal position, etc.).

By way of example only, the features that are operable to providemotorized actuation of firing beam (82) may be configured and operablein accordance with at least some of the teachings of U.S. Pat. No.8,210,411, entitled “Motor-Driven Surgical Instrument,” issued Jul. 3,2012, the disclosure of which is incorporated by reference herein. Asanother merely illustrative example, the features that are operable toprovide motorized actuation of firing beam (82) may be configured andoperable in accordance with at least some of the teachings of U.S. Pat.No. 8,453,914, entitled “Motor-Driven Surgical Cutting Instrument withElectric Actuator Directional Control Assembly,” issued Jun. 4, 2013,the disclosure of which is incorporated by reference herein. As yetanother merely illustrative example, the features that are operable toprovide motorized actuation of firing beam (82) may be configured andoperable in accordance with at least some of the teachings of U.S.patent application Ser. No. 14/226,142, entitled “Surgical InstrumentComprising a Sensor System,” filed Mar. 26, 2014, issued as U.S. Pat.No. 9,913,642 on Mar. 13, 2018, the disclosure of which is incorporatedby reference herein.

Other suitable components, features, and configurations that may be usedto provide motorization of firing beam (82) will be apparent to those ofordinary skill in the art in view of the teachings herein. It shouldalso be understood that some other versions may provide manual drivingof firing beam (82), such that a motor may be omitted. By way of exampleonly, firing beam (82) may be manually actuated in accordance with atleast some of the teachings of any other reference cited herein.

FIG. 8 shows end effector (40) having been actuated through a singlestroke through tissue (90). As shown, cutting edge (84) (obscured inFIG. 8) has cut through tissue (90), while staple drivers (75) havedriven two alternating rows of staples (77) through the tissue (90) oneach side of the cut line produced by cutting edge (84). Staples (77)are all oriented substantially parallel to the cut line in this example,though it should be understood that staples (77) may be positioned atany suitable orientations. In the present example, end effector (40) iswithdrawn from the trocar after the first stroke is complete, the spentstaple cartridge (70) is replaced with a new staple cartridge (70), andend effector (40) is then again inserted through the trocar to reach thestapling site for further cutting and stapling. This process may berepeated until the desired amount of cuts and staples (77) have beenprovided. Anvil (60) may need to be closed to facilitate insertion andwithdrawal through the trocar; and anvil (60) may need to be opened tofacilitate replacement of staple cartridge (70).

It should be understood that cutting edge (84) may cut tissuesubstantially contemporaneously with staples (77) being driven throughtissue during each actuation stroke. In the present example, cuttingedge (84) just slightly lags behind driving of staples (77), such that astaple (47) is driven through the tissue just before cutting edge (84)passes through the same region of tissue, though it should be understoodthat this order may be reversed or that cutting edge (84) may bedirectly synchronized with adjacent staples. While FIG. 8 shows endeffector (40) being actuated in two layers (92, 94) of tissue (90), itshould be understood that end effector (40) may be actuated through asingle layer of tissue (90) or more than two layers (92, 94) of tissue.It should also be understood that the formation and positioning ofstaples (77) adjacent to the cut line produced by cutting edge (84) maysubstantially seal the tissue at the cut line, thereby reducing orpreventing bleeding and/or leaking of other bodily fluids at the cutline. Furthermore, while FIG. 8 shows end effector (40) being actuatedin two substantially flat, apposed planar layers (92, 94) of tissue, itshould be understood that end effector (40) may also be actuated acrossa tubular structure such as a blood vessel, a section of thegastrointestinal tract, etc. FIG. 8 should therefore not be viewed asdemonstrating any limitation on the contemplated uses for end effector(40). Various suitable settings and procedures in which instrument (10)may be used will be apparent to those of ordinary skill in the art inview of the teachings herein.

It should also be understood that any other components or features ofinstrument (10) may be configured and operable in accordance with any ofthe various references cited herein. Additional exemplary modificationsthat may be provided for instrument (10) will be described in greaterdetail below. Various suitable ways in which the below teachings may beincorporated into instrument (10) will be apparent to those of ordinaryskill in the art. Similarly, various suitable ways in which the belowteachings may be combined with various teachings of the references citedherein will be apparent to those of ordinary skill in the art. It shouldtherefore be understood that the teachings below may be readilyincorporated into the various instruments taught in the variousreferences that are cited herein. It should also be understood that thebelow teachings are not limited to instrument (10) or devices taught inthe references cited herein. The below teachings may be readily appliedto various other kinds of instruments, including instruments that wouldnot be classified as surgical staplers. Various other suitable devicesand settings in which the below teachings may be applied will beapparent to those of ordinary skill in the art in view of the teachingsherein.

II. Exemplary Buttress for Surgical Stapler

As noted above, it may be desirable in some instances to equip endeffector (40) with a buttress material to reinforce the mechanicalfastening of tissue (90) provided by staples (77). Such a buttress mayprevent the applied staples (77) from pulling through tissue (90) andmay otherwise reduce a risk of tissue (90) tearing at or near the siteof applied staples (77). In addition to or as an alternative toproviding structural support and integrity to a line of staples (77), abuttress may provide various other kinds of effects such as spacing orgap-filling, administration of therapeutic agents, and/or other effects.In some instances, a buttress may be provided on deck (73) of staplecartridge (70). In some other instances, a buttress may be provided onthe surface of anvil (60) that faces staple cartridge (70). It shouldalso be understood that a first buttress may be provided on deck (73) ofstaple cartridge (70) while a second buttress is provided on anvil (60)of the same end effector (40). Various examples of forms that a buttressmay take will be described in greater detail below. Various ways inwhich a buttress may be secured to a staple cartridge (70) or an anvil(60) will also be described in greater detail below.

A. Exemplary Composition of Buttress for Surgical Stapler

FIG. 9 shows an exemplary buttress assembly (100) with a basiccomposition. Buttress assembly (100) of this example comprises abuttress body (102), an upper adhesive layer (104), and a lower adhesivelayer (106). In the present example, buttress body (102) comprises astrong yet flexible material configured to structurally support a lineof staples (77). In addition or in the alternative, buttress body (102)may comprise a material including, for example, a hemostatic agent suchas fibrin to assist in coagulating blood and reduce bleeding at thesevered and/or stapled surgical site along tissue (90).

As another merely illustrative example, buttress body (102) may compriseother adjuncts or hemostatic agents such as thrombin may be used suchthat buttress body (102) may assist to coagulate blood and reduce theamount of bleeding at the surgical site. The hemostatic abilities ofsuch adjuncts may also contribute to the use of such adjuncts asadhesives and sealants. The agents may assist to coagulate blood at asurgical site, which allows tissue surrounding such blood to sticktogether and may prevent leaks along the stapled tissue site, forexample. Other adjuncts or reagents that may be incorporated intobuttress body (102) may further include but are not limited to medicalfluid or matrix components. By way of example only, buttress body (102)may include natural or genetically engineered absorbable polymers orsynthetic absorbable polymers, or mixtures thereof. Merely illustrativeexamples of natural or genetically engineered absorbable polymers areproteins, polysaccharides and combinations thereof. Merely illustrativeexamples of proteins that may be used include prothrombin, thrombin,fibrinogen, fibrin, fibronectin, heparinase, Factor X/Xa, FactorVII/VIIa, Factor IX/IXa, Factor XI/XIa, Factor XII/XIIa, tissue factor,batroxobin, ancrod, ecarin, von Willebrand Factor, collagen, elastin,albumin, gelatin, platelet surface glycoproteins, vasopressin,vasopressin analogs, epinephrine, selectin, procoagulant venom,plasminogen activator inhibitor, platelet activating agents, syntheticpeptides having hemostatic activity, and/or combinations thereof.Polysaccharides include, without limitation, cellulose, alkyl cellulose,e.g. methylcellulose, alkylhydroxyalkyl cellulose, hydroxyalkylcellulose, cellulose sulfate, salts of carboxymethyl cellulose,carboxymethyl cellulose, carboxyethyl cellulose, chitin, carboxymethylchitin, hyaluronic acid, salts of hyaluronic acid, alginate, alginicacid, propylene glycol alginate, glycogen, dextran, dextran sulfate,curdlan, pectin, pullulan, xanthan, chondroitin, chondroitin sulfates,carboxymethyl dextran, carboxymethyl chitosan, chitosan, heparin,heparin sulfate, heparan, heparan sulfate, dermatan sulfate, keratansulfate, carrageenans, chitosan, starch, amylose, amylopectin,poly-N-glucosamine, polymannuronic acid, polyglucuronic acidpolyguluronic acid, and derivatives of any of the above. Examples ofsynthetic absorbable polymers are aliphatic polyester polymers,copolymers, and/or combinations thereof. The aliphatic polyesters aretypically synthesized in a ring opening polymerization of monomersincluding, but not limited to, lactic acid, lactide (including L-, D-,meso and D, L mixtures), glycolic acid, glycolide, ε-caprolactone,p-dioxanone (1,4-dioxan-2-one), and trimethylene carbonate(1,3-dioxan-2-one). Other suitable compounds, materials, substances,etc., that may be used in a medical fluid or matrix will be apparent tothose of ordinary skill in the art in view of the teachings herein.

Buttress body (102) may alternatively comprise a fibrous pad, a foam, amesh, a weave, and/or another structure capable of containing anadhesive and/or other type of medical fluid. In addition or in thealternative, buttress body (102) may simply comprise a mesh, a weave,and/or some other structure that is constructed to provide structuralsupport or integrity to a line of staples (77) applied through tissue(90). Such a material and structure may be relatively thin and in someinstances may be substantially non-compressible. By way of furtherexample only, buttress body (102) may be constructed in accordance withat least some of the teachings of U.S. Patent Pub. No. 2012/0241493,entitled “Tissue Thickness Compensator Comprising Controlled Release andExpansion,” published Sep. 27, 2012, issued as U.S. Pat. No. 10,123,798on Nov. 13, 2018, the disclosure of which is incorporated by referenceherein; U.S. Patent Pub. No. 2013/0068816, entitled “Surgical Instrumentand Buttress Material,” published Mar. 21, 2013, now abandoned, thedisclosure of which is incorporated by reference herein; U.S. PatentPub. No. 2013/0062391, entitled “Surgical Instrument with Fluid FillableButtress,” published Mar. 14, 2013, issued as U.S. Pat. No. 9,999,408 onJun. 19, 2018, the disclosure of which is incorporated by referenceherein; U.S. Patent Pub. No. 2013/0068820, entitled “Fibrin Pad Matrixwith Suspended Heat Activated Beads of Adhesive,” published Mar. 21,2013, issued as U.S. Pat. No. 8,814,025 on Aug. 26, 2014, the disclosureof which is incorporated by reference herein; U.S. Patent Pub. No.2013/0082086, entitled “Attachment of Surgical Staple Buttress toCartridge,” published Apr. 4, 2013, issued as U.S. Pat. No. 8,899,464 onDec. 2, 2014, the disclosure of which is incorporated by referenceherein; U.S. Patent Pub. No. 2013/0037596, entitled “Device for ApplyingAdjunct in Endoscopic Procedure,” published Feb. 14, 2013, issued asU.S. Pat. No. 9,492,170 on Nov. 15, 2016, the disclosure of which isincorporated by reference herein; U.S. Patent Pub. No. 2013/0062393,entitled “Resistive Heated Surgical Staple Cartridge with Phase ChangeSealant,” published Mar. 14, 2013, issued as U.S. Pat. No. 8,998,060 onApr. 7, 2015, the disclosure of which is incorporated by referenceherein; U.S. Patent Pub. No. 2013/0075446, entitled “Surgical StapleAssembly with Hemostatic Feature,” published Mar. 28, 2013, issued asU.S. Pat. No. 9,383,018 on Jul. 19, 2016, the disclosure of which isincorporated by reference herein; U.S. Patent Pub. No. 2013/0062394,entitled “Surgical Staple Cartridge with Self-Dispensing StapleButtress,” published Mar. 14, 2013, issued as U.S. Pat. No. 9,101,359 onAug. 11, 2015, the disclosure of which is incorporated by referenceherein; U.S. Patent Pub. No. 2013/0075445, entitled “Anvil Cartridge forSurgical Fastening Device,” published Mar. 28, 2013, issued as U.S. Pat.No. 9,198,644 on Dec. 1, 2015, the disclosure of which is incorporatedby reference herein; U.S. Patent Pub. No. 2013/0075447, entitled“Adjunct Therapy for Applying Hemostatic Agent,” published Mar. 28,2013, now abandoned, the disclosure of which is incorporated byreference herein; and/or U.S. Patent Pub. No. 2013/0256367, entitled“Tissue Thickness Compensator Comprising a Plurality of Medicaments,”published Oct. 3, 2013, issued as U.S. Pat. No. 9,211,120 on Dec. 15,2015, the disclosure of which is incorporated by reference herein.

In the present example, buttress body (102) comprises a woven mesh ofVICRYL® (polyglactin 910) material by Ethicon US, LLC. VICRYL® wovenmesh is prepared from a synthetic absorbable copolymer of glycolide andlactide, derived respectively from glycolic and lactic acids. Thistightly woven mesh is prepared from uncoated, undyed fiber identical incomposition to that used in VICRYL® synthetic absorbable suture, whichhas been found to be inert, nonantigenic, nonpyrogenic, and to elicitonly a mild tissue reaction during absorption. VICRYL® woven mesh isintended for use as a buttress to provide temporary support during thehealing process. Alternatively, any other suitable materials orcombinations of materials may be used in addition to or as analternative to VICRYL® material to form buttress body (102).

In versions where buttress body (102) is formed as a mesh, it should beunderstood that various kinds of mesh geometry may be used. By way ofexample only, buttress body (102) may be formed as a woven mesh, aknitted mesh, or a warp knitted mesh. Regardless of whether buttressbody (102) is formed as a mesh or not, buttress body (102) is porous insome examples. As described in greater detail below, an adhesive layer(104, 106) may be provided on buttress body (102) in order to adherebuttress body (102) to underside (65) of anvil (60) or deck (73) ofstaple cartridge (70). In some versions where buttress body (102) isporous, the material forming adhesive layer (104, 106) may pass throughbuttress body (102) to reach the outer surface of buttress body (102)that is opposite to the surface on which adhesive layer (104, 106) isdisposed.

By way of example only, upper adhesive layer (104) may be used to securebuttress assembly (100) to the underside (304) of a retainer (300) aswill be described in greater detail below; while lower adhesive layer(106) is used to secure buttress assembly (100) to deck (73) of staplecartridge (70). In some versions of this example, lower adhesive layer(106) is configured to provide stronger adherence than upper adhesivelayer (104). In some illustrative variations of this example, one ormore features of retainer (300) (e.g., flanges, clips, etc.) areconfigured to selectively retain buttress assembly (100) againstunderside (304) of retainer (300), such that upper adhesive layer (104)is omitted; while lower adhesive layer (106) is used to secure buttressassembly (100) to deck (73) of staple cartridge (70). In addition or inthe alternative, an adhesive material may be applied to the lowersurface of a porous version of buttress body (102) to form loweradhesive layer (106), and some of that adhesive material may passthrough buttress body (102) to form upper adhesive layer (104). In somesuch versions, lower adhesive layer (106) ultimately has more adhesivematerial than upper adhesive layer (104), such that lower adhesive layer(106) provides greater adhesion than upper adhesive layer (104).

In yet another merely illustrative example, lower adhesive layer (106)may be used to secure buttress assembly (100) to the upper side (302) ofa retainer (300) as will be described in greater detail below; whileupper adhesive layer (104) is used to secure buttress assembly tounderside (65) of anvil (60) of end effector (40). In some versions ofthis example, upper adhesive layer (104) is configured to providestronger adherence than lower adhesive layer (106). In some illustrativevariations of this example, one or more features of retainer (300)(e.g., flanges, clips, etc.) are configured to selectively retainbuttress assembly (100) against upper side (302) of retainer (300), suchthat lower adhesive layer (106) is omitted; while upper adhesive layer(104) is used to secure buttress assembly (100) to underside (65) ofanvil (60). In addition or in the alternative, an adhesive material maybe applied to the upper surface of a porous version of buttress body(102) to form upper adhesive layer (104), and some of that adhesivematerial may pass through buttress body (102) to form lower adhesivelayer (106). In some such versions, upper adhesive layer (104)ultimately has more adhesive material than lower adhesive layer (106),such that upper adhesive layer (104) provides greater adhesion thanlower adhesive layer (106).

Various suitable compositions that may be used to form each adhesivelayer (104, 106), as well as various forms that each adhesive layer(104, 106) may take, will be described in greater detail below.

It should also be understood that buttress assembly (100) may include animpermeable layer or a semi impermeable layer interposed betweenbuttress body (102) and adhesive layer (102), to prevent or restrictmigration of adhesive material from adhesive layer (104, 106) intobuttress body (100). By way of example only, body (102) may be formed ofa porous media (e.g., ETHISORB™ by Codman of Raynham, Mass.); while thesemi impermeable layer may comprise polydioxanone (PDS). In versionswhere buttress assembly (100) comprises an impermeable layer or a semiimpermeable layer to prevent or restrict migration of adhesive materialfrom adhesive layer (104, 106) into buttress body (100), such a layermay be integrated into buttress body (102) such that the layer permitsthe adhesive to migrate at least partially into buttress body (102) butnot across the full thickness of buttress body (102). Various suitableways in which an impermeable layer or a semi impermeable layer may beintegrated into buttress assembly (100) to prevent or restrict migrationof an adhesive material will be apparent to those of ordinary skill inthe art in view of the teachings herein.

B. Exemplary Instrument and Technique for Securing Buttress to Deck ofStaple Cartridge

FIGS. 10-12D show a combination of an exemplary buttress (200) with anexemplary retainer (300). Buttress (200) of this example may beconstructed in accordance with the teachings above relating to buttressassembly (100) and/or in accordance with other teachings herein.Buttress (200) includes an upper side (202) and an underside (204). Inthe present example, underside (204) includes an adhesive (e.g., likelower adhesive layer (106)) to secure buttress (200) to deck (73) ofstaple cartridge (70) as described in greater detail below.

Retainer (300) of this example comprises an upper side (302), anunderside (304), a distally projecting tongue (306), and a set ofresilient latches (308). Upper side (302) and underside (304) are eachgenerally flat in the present example, though it should be understoodthat upper side (302) and/or underside (304) may include various kindsof features as described elsewhere herein. Tongue (306) is configured toprovide a grip for an operator, thereby facilitating grasping andhandling of retainer (300) during use. Latches (308) are configured toreleasably secure retainer (300) to lower jaw (50) of end effector (40)as will be described in greater detail below. By way of example only,retainer (300) may be formed of molded plastic. Alternatively, retainer(300) may be formed using any other suitable material(s) ortechnique(s).

In the present example, buttress (200) is secured to underside (304) ofretainer (300), such that upper side (202) of buttress (200) apposesunderside (304) of retainer (300). In some versions, an adhesive such asupper adhesive layer (104) provides releasable adhesion of buttress(200) to underside (304) of retainer (300). In some other versions,retainer (300) includes one or more features (e.g., flanges, clips,etc.) that are configured to selectively retain buttress (200) againstunderside (304) of retainer (300). Various suitable ways in whichbuttress (200) may be releasably secured to underside (304) of retainer(300) will be apparent to those of ordinary skill in the art in view ofthe teachings herein.

As shown in FIG. 12A, the assembly formed by buttress (200) and retainer(300) may be placed before end effector (40) with anvil (60) in the openposition. In some instances, a peel-away film (not shown) is positionedover underside (204) of buttress (200) to protect buttress (200) and/orany adhesive material on underside (204) of buttress (200). In suchversions, the film is peeled away to expose underside (204) of buttress(200) before reaching the stage shown in FIG. 12A. Such a film maycomprise polytetrafluoroethylene (PTFE) and/or any other suitablematerial(s). After reaching the stage shown in FIG. 12A, the assemblyformed by buttress (200) and retainer (300) may then be placed on staplecartridge (70) such that underside (204) of buttress (200) apposinglycontacts deck (73) of staple cartridge (70); and such that latches (308)are releasably secured to lower jaw (50) as shown in FIG. 12B. Theoperator may then drive anvil (60) toward the closed position as shownin FIG. 12C, eventually compressing buttress (200) against deck (73) ofstaple cartridge (70). Such compression may promote adhesion betweenunderside (204) of buttress (200) and deck (73) of staple cartridge(70). After anvil (60) has been used to compress buttress (200) againstdeck (73) of staple cartridge (70), anvil (60) may be moved back to theopen position as shown in FIG. 12D. As also shown in FIG. 12D, retainer(300) may then be pulled away from end effector (40), leaving behindbuttress (200) adhered to deck (73) of staple cartridge (70). Upper side(202) of buttress (200) is exposed. End effector (40) is thus loadedwith buttress (200) and ready for use in severing and stapling tissue(90).

FIGS. 13A-13C show an end effector (40) loaded with buttress (200) beingused to drive a staple (77) through tissue (90). In FIG. 13A, tissue(90) is placed between anvil (60) and staple cartridge (70), abovebuttress (200), with anvil (60) in the open position. In FIG. 13B, anvil(60) is driven to the closed position, compressing tissue (90) againstbuttress (200) and staple cartridge (70). End effector (40) is thenactuated as described above, driving staple (77) through buttress (200)and tissue (90). As shown in FIG. 13C, crown (210) of driven staple (77)captures and retains buttress (200) against layer (94) of tissue (90).It should be understood that a series of staples (77) will similarlycapture and retain buttress (200) against layer (94) of tissue (90),thereby securing buttress (200) to tissue (90) as shown in FIG. 14. Asend effector (40) is pulled away from tissue (90) after deployingstaples (77) and buttress (200), buttress (200) disengages deck (73) ofstaple cartridge (70), such that buttress (200) remains secured totissue (90) with staples (77). Buttress (200) thus provides structuralreinforcement to the lines of staples (77). As can also be seen in FIG.14, knife member (80) also cuts through a centerline of buttress (200),separating buttress (200) into two sections (230, 240), such that eachsection (230, 240) remains secured to a respective severed region oftissue (90).

C. Exemplary Instrument and Technique for Securing Buttress to Anvil ofEnd Effector

FIGS. 15-17B show a combination of an exemplary buttress (400) withretainer (300). Buttress (400) of this example may be constructed inaccordance with the teachings above relating to buttress assembly (100)and/or in accordance with other teachings herein. Buttress (400)includes an upper side (402) and an underside (404). In the presentexample, upper side (402) includes an adhesive (e.g., like upperadhesive layer (1064) to secure buttress (200) to underside (65) ofanvil (60) as described in greater detail below.

In the present example, buttress (400) is secured to upper side (302) ofretainer (300), such that underside (404) of buttress (400) apposesupper side (302) of retainer (300). In some versions, an adhesive suchas lower adhesive layer (106) provides releasable adhesion of buttress(400) to upper side (302) of retainer (300). In some other versions,retainer (300) includes one or more features (e.g., flanges, clips,etc.) that are configured to selectively retain buttress (400) againstupper side (302) of retainer (300). Various suitable ways in whichbuttress (200) may be releasably secured to upper side (302) of retainer(300) will be apparent to those of ordinary skill in the art in view ofthe teachings herein.

As shown in FIG. 17A, the assembly formed by buttress (400) and retainer(300) may be placed before end effector (40) with anvil (60) in the openposition. In some instances, a peel-away film (not shown) is positionedover upper side (402) of buttress (400) to protect buttress (400) and/orany adhesive material on upper side (402) of buttress (400). In suchversions, the film is peeled away to expose upper side (402) of buttress(400) before reaching the stage shown in FIG. 17A. Such a film maycomprise polytetrafluoroethylene (PTFE) and/or any other suitablematerial(s). After reaching the stage shown in FIG. 17A, the assemblyformed by buttress (400) and retainer (300) may then be placed on staplecartridge (70) such that latches (308) are releasably secured to lowerjaw (50) as described above. The operator may then drive anvil (60)toward the closed position as described above, eventually compressingbuttress (400) underside (65) of anvil (60). Such compression maypromote adhesion between upper side (402) of buttress (400) andunderside (65) of anvil (60). After anvil (60) has been used to compressbuttress (200) against underside (65) of anvil (60), anvil (60) may bemoved back to the open position as shown in FIG. 17B. As also shown inFIG. 17B, retainer (300) may then be pulled away from end effector (40),leaving behind buttress (400) adhered to underside (65) of anvil (60).Underside (402) of buttress (400) is exposed. End effector (40) is thusloaded with buttress (400) and ready for use in severing and staplingtissue (90).

FIGS. 18A-18C show an end effector (40) loaded with buttress (400) beingused to drive a staple (77) through tissue (90). In FIG. 18A, tissue(90) is placed between anvil (60) and staple cartridge (70), belowbuttress (400), with anvil (60) in the open position. In FIG. 18B, anvil(60) is driven to the closed position, compressing tissue (90) againstbuttress (400) and staple cartridge (70). End effector (40) is thenactuated as described above, driving staple (77) through buttress (400)and tissue (90). As shown in FIG. 18C, bent legs (220) of driven staple(77) capture and retains buttress (400) against layer (92) of tissue(90). It should be understood that a series of staples (77) willsimilarly capture and retain buttress (400) against layer (92) of tissue(90), thereby securing buttress (400) to tissue (90) as shown in FIG.19. As anvil (60) is returned to the open position to enable endeffector (40) to be pulled away from tissue (90) after deploying staples(77) and buttress (400), buttress (400) disengages underside (65) ofanvil (60), such that buttress (400) remains secured to tissue (90) withstaples (77). Buttress (400) thus provides structural reinforcement tothe lines of staples (77). As can also be seen in FIG. 19, knife member(80) also cuts through a centerline of buttress (400), separatingbuttress (400) into two sections (430, 440), such that each section(430, 440) remains secured to a respective severed region of tissue(90).

While the examples above provide either buttress (200) on underside(304) of retainer (300) or buttress (400) on upper side (302) ofretainer (300), it should be understood that both retainers (200, 400)may be provided on the same retainer (300) if desired. In particular,retainer (200) may be provided on underside (304) of retainer (300)while buttress (400) is provided on upper side (302) of retainer (300).This may result in buttress (200) being provided on deck (73) of staplecartridge (70) and buttress (400) being provided on underside (65) ofanvil (60) in the same end effector (400). This may ultimately result inbuttress (200) being secured against layer (94) of tissue (90) by crowns(210) of staples (77) while buttress (400) is secured against layer (92)of tissue (90) by bent legs (220) of the same staples (77).

III. Exemplary Materials and Techniques for Providing Adhesion ofButtress to Surgical Stapler

As noted above, a buttress assembly (100) may include at least one layer(104, 106) of adhesive material (or other form of adhesive material)that adheres buttress body (102) to either underside (65) of anvil (60)or deck (73) of staple cartridge (70). Such an adhesive material mayprovide proper positioning of buttress body (102) before and duringactuation of end effector (40); then allow buttress body (102) toseparate from end effector (40) after end effector (40) has beenactuated, without causing damage to buttress body (102) that issubstantial enough to compromise the proper subsequent functioning ofbuttress body (102). It may be desirable to minimize the impact of suchan adhesive material on the functioning of firing beam (82) wedge sled(78), and staple drivers (75). For instance, it may be desirable toprevent the adhesive material from blocking or otherwise providingsignificant resistance to movement of firing beam (82) wedge sled (78),and staple drivers (75). Moreover, the adhesive material should allowbuttress body (102) to detach easily enough from an actuated endeffector (40) to avoid tearing tissue (90) after staples (77) have beenfired through the tissue and anvil (60) is moved to the open position.

In some instances, it may be desirable for the adhesive material toprovide additional effects, beyond merely adhering buttress body (102)to either underside (65) of anvil (60) or deck (73) of staple cartridge(70). For instance, the adhesive material may include one or morecomponents that provide a therapeutic effect, hemostatic effect, orother desired effect on tissue (90). As another merely illustrativeexample, the adhesive material may fill in at least part of the pathsthat are formed through tissue (90) and/or buttress body (102) by legs(220) of staple (77) being driven through tissue (90) and buttress body(102).

In some instances, the adhesive material for a buttress body (102) maybe pressure sensitive. In addition or in the alternative, the adhesivematerial may be configured to take the form of surface irregularities ofbuttress body (102); in addition to or in lieu of taking the form ofsurface irregularities in underside (65) of anvil (60) and/or deck (73)of staple cartridge (70).

The above noted characteristics of an adhesive material for a buttressbody (102) are merely illustrative examples. Suitable adhesive materialsmay possess various other characteristics in addition to or in lieu ofthose above. Suitable adhesive materials may also be provided in variousdifferent kinds of compositions. Examples of various suitablecompositions and configurations that may be used to form and provide anadhesive material for a buttress body (102), as well as variousexemplary characteristics that such adhesive material may possess, aredescribed in greater detail below.

A. Exemplary Polymeric Adhesive Materials with Synthetic Base

In some instances, an adhesive material (e.g., one or more of layers(104, 106)) for a buttress body (102) comprises an absorbable syntheticbased polymer. Various physiomechanical properties of synthetic basedpolymers may be modified in order to provide different adhesiveproperties. Such variable characteristics include but are not limited tocopolymer composition, glass transition temperature (Tg), molecularweight, inherent viscosity (IV), crystallinity, sequence distribution,copolymer chain composition, melting temperature (Tm), and surfacetension. Several exemplary combinations of these variables will beprovided below, though it should be understood that these examples aremerely illustrative. It should also be understood that these examples ofadhesive materials may be provided in upper adhesive layer (104). Inaddition or in the alternative, these examples of adhesive materials maybe provided in lower adhesive layer (106). In addition or in thealternative, these examples of adhesive materials may be otherwiseintegrated into buttress body (102). It should therefore be understoodthat the adhesive material need not necessarily constitute a separatelayer that is discretely identifiable as being different from a layerdefined by buttress body (102).

In some examples, the adhesive material is formed by a copolymer oflactide and caprolactone (PLA/PCL). This composition may be provided ata ratio in the range of 20/80 to 60/40; or more particularly the rangeof 35/65 to 50/50. This composition may have a glass transitiontemperature (Tg) that is below 4° C., or more particularly below −10° C.This composition may have a molecular weight in the range of 10,000g/mol to 145,000 g/mol; or more particularly below 200,000 g/mol. Thecomposition may have an inherent viscosity (IV) in the range of 1.0 dL/gto 2.0 dL/g.

In some other examples, the adhesive material is formed by a copolymerof lactide and trimethylene carbonate (PLA/TMC). This composition may beprovided at a ratio in the range of 20/80 to 50/50. The othercharacteristics may be within the same parameters set forth above withrespect to the exemplary PLA/PCL composition. Alternatively, the PLA/TMCcomposition may have any other suitable characteristics.

In some other examples, the adhesive material is formed by a copolymerof trimethylene carbonate and caprolactone (TMC/PCL). This compositionmay be provided at a ratio in the range of 20/80 to 80/20; or moreparticularly in the range of 50/50 to 60/40. This composition may havean inherent viscosity (IV) in the range of 0.3 dL/g to 3.0 dL/g; or moreparticularly in the range of 0.5 dL/g to 1.0 dL/g. This composition mayhave a crystallinity below 20%; or more particularly below 5%; or moreparticularly at 0% (i.e., a completely amorphous polymer). Thiscomposition may have a glass transition temperature (Tg) below 0° C.; ormore particularly below −20° C.

In some other examples, the adhesive material is formed by a copolymerof caprolactone and glycolide (PCL/PGA). This composition may beprovided at a ratio in the range of 45/55 to 85/15; or more particularlyin the range of 40/60 to 65/35; or more particularly in the range of50/50 to 65/35. This composition may have an inherent viscosity (IV) inthe range of 0.2 dL/g to 3.0 dL/g; or more particularly in the range of1.0 dL/g to 2.0 dL/g. This composition may have a molecular weight inthe range of 100,000 g/mol to 200,000 g/mol. This composition may have acrystallinity below 20%; or more particularly below 5%; or moreparticularly at 0% (i.e., a completely amorphous polymer). Thiscomposition may have a glass transition temperature (Tg) below 0° C.; ormore particularly below −20° C. One particular example of thiscomposition has a ratio of 50/50 PCL/PGA; an inherent viscosity (IV) of0.2; a molecular weight of 83,000 g/mol; and a glass transitiontemperature (Tg) of −19.4°. Another particular example of thiscomposition has a ratio of 65/35 PCL/PGA; an inherent viscosity (IV) of1.04 to 1.07; a molecular weight of 110,000 g/mol to 118,000 g/mol; anda glass transition temperature (Tg) in the range of −37.3° to −38.6°.

Other exemplary synthetic based polymer compositions that may be used toform the adhesive material include the following: propanediol andcaprolactone (PDO/PCL); a combination of propanediol, caprolactone, andtrimethylene carbonate (PDO/PCL/TMC), with very low to no crystallinityand a glass transition temperature (Tg) below 0° C.; and a homopolymerpoly(TMC), with an inherent viscosity (IV) of approximately 0.5 dL/g.Other suitable synthetic based polymer compositions will be apparent tothose of ordinary skill in the art in view of the teachings herein.

The adhesive material may include a blocky copolymer. For instance, oneexample of a blocky copolymer that may be used in the adhesive materialcomprises blocky poly(TMC), with a low glass transition temperature(Tg). In some instances, the blocky copolymer may be randomized. In someother instances, such as when the copolymer is amorphous (e.g., 0%crystallinity), the blocky copolymer may be ordered.

The adhesive material may include various kinds of copolymer chaincompositions. For instance, the copolymer chain composition may bebranched with relatively short segments. This may further enhance themalleability experience. Alternatively, the copolymer chain may belinear. As another alternative, the copolymer may be cross-linked orstar pattern. However, in versions where the copolymer is cross-linked,it may be desirable for the base copolymer segments to be more amorphousthe more that those segment are cross-linked.

As noted above, the melting temperature (Tm) is a physiomechanicalproperty of a polymer that may be selected to provide desired adhesivecharacteristics. In some instances, the lower melting temperature (Tm)of a monomer component could limit the amount of the co-monomer neededto create a desired adhesive effect. By way of example only,polydioxanone (PDS) has a melting temperature (Tm) around approximately110° C. and a glass transition temperature (Tg) around approximately−10° C. Thus, polydioxanone (PDS) may need less caprolactone (PCL) tomake a suitable pressure sensitive adhesive (PSA) copolymer. It shouldalso be understood that polydioxanone (PDS) copolymers withpolyglycolide (PGA) or lactide (PLA) may provide desired adhesiveeffects. It may be desirable for such copolymers to have a glasstransition temperature (Tg) that is below room temperature; a meltingtemperature (Tm) that is at or below room temperature; a crystallinityin the range of 10% to 0%; and an inherent viscosity (IV) that is lessthan 2.0 dL/g, or more particularly less than 1.0 dL/g.

In some examples the adhesive material may comprise a blended copolymer.For instance, the high and low molecular weight of the same pressuresensitive adhesive (PSA) copolymer may allow for the degradation rate tobe adjusted without adjusting the polymer chemistry. As the lowmolecular weight version breaks down, its acid byproducts would thenchange the pH and effect the breakdown of the high molecular weightparts. Preferred blends of copolymers would include those that will notaffect the crystallinity, low melting temperature (Tm), and low glasstransition temperature (Tg) of the copolymers.

Some examples of the adhesive material may comprise polyurethane. Forinstance, the polyurethane may be provided as a pressure sensitiveadhesive (PSA). By of example only, polyurethane based pressuresensitive adhesives (PSAs) may be prepared from isocyanates, polyols,and chain extenders. Pressure sensitive adhesives (PSAs) may also beprepared from 100% solids, waterborne, or solvent borne systems. Theproperties of polyurethane based pressure sensitive adhesives (PSAs) maybe controlled by varying the ratio of isocyanates to polyols and chainextenders. As another merely illustrative example, the polyurethane maybe provided in a flowable form. For instance, a flowable polyurethanebased adhesive material may have an inherent viscosity (IV) that is lessthan 1.0 dL/g, or more particularly less than 0.5 dL/g; a glasstransition temperature (Tg) that is in the range of −10° C. and 10° C.;or more particularly closer to −10° C.; and a consistency similar tothat of honey or oil, if desired, with the proper inherent viscosity(IV).

The foregoing examples of absorbable synthetic based polymers areprovided for merely illustrative purposes. Other suitable examples willbe apparent to those of ordinary skill in the art in view of theteachings herein. It should also be understood that the foregoingexamples of absorbable synthetic based polymers may be readilyincorporated into the various teachings and examples provided below. Inother words, the foregoing examples of absorbable synthetic basedpolymers may be readily incorporated into any example herein that refersto an adhesive material.

B. Exemplary Polymeric Adhesive Materials with Natural Base

While the above discussion provides various examples of synthetic basedpolymers that may be used as an adhesive material (e.g., one or more oflayers (104, 106)) for a buttress body (102), it should also beunderstood that a natural based polymer may be used as an adhesivematerial. Several merely illustrative examples of natural based polymersthat may be used as an adhesive material will be described in greaterdetail below. It should also be understood that these examples ofadhesive materials may be provided in upper adhesive layer (104). Inaddition or in the alternative, these examples of adhesive materials maybe provided in lower adhesive layer (106). In addition or in thealternative, these examples of adhesive materials may be otherwiseintegrated into buttress body (102). It should therefore be understoodthat the adhesive material need not necessarily constitute a separatelayer that is discretely identifiable as being different from a layerdefined by buttress body (102).

In some instances, the adhesive material comprises a hydrogel. Thehydrogel may generally comprise a hydrophilic polymer network capable ofabsorbing and/or retaining fluids. An exemplary hydrogel material isglycol methacrylate. By way of further example only, suitable hydrogelmaterials may comprise homopolymer hydrogels, copolymer hydrogels,multipolymer hydrogels, interpenetrating polymer hydrogels, andcombinations thereof. In further examples, the hydrogel may comprisemicrogels, nanogels, and combinations thereof. The hydrogel may furthercomprise a non-crosslinked hydrogel, a crosslinked hydrogel, andcombinations thereof. The hydrogel may comprise chemical crosslinks,physical crosslinks, hydrophobic segments and/or water insolublesegments. The hydrogel may be chemically crosslinked by polymerization,small-molecule crosslinking, and/or polymer-polymer crosslinking. Thehydrogel may be physically crosslinked by ionic interactions,hydrophobic interactions, hydrogen bonding interactions,sterocomplexation, and/or supramolecular chemistry. The hydrogel may besubstantially insoluble due to the crosslinks, hydrophobic segmentsand/or water insoluble segments, but be expandable and/or swellable dueto absorbing and/or retaining fluids. In some versions, the precursormay crosslink with endogenous materials and/or tissues.

Further examples of hydrogels that may be used include multifunctionalacrylates, hydroxyethylmethacrylate (HEMA), and elastomeric acrylates.In additional or in the alternative, a hydrogel adhesive material may beconstructed in accordance with at least some of the teachings of U.S.Pat. Pub. No. 2012/0241492, entitled “Tissue Thickness CompensatorComprising at Least One Medicament,” published Sep. 27, 2012, issued asU.S. Pat. No. 9,839,420 on Dec. 12, 2017, the disclosure of which isincorporated by reference herein. Other suitable ways in which anadhesive material may be provided with hydrogel will be apparent tothose of ordinary skill in the art in view of the teachings herein.

Further examples of naturally based polymers that may be used to form anadhesive material include alginate (e.g., calcium alginate, calciumsodium alginate, etc.); hyaluronic acid, collagen (including gelatin),and polysaccharide. In versions including a polysaccharide, thepolysaccharide may include cellulose, chitin, pectin, or arabinoxylans.In versions including cellulose, the cellulose may comprise oxidizedregenerated cellulose, carboxy-methylcellulose, carboxyethyl cellulose,hydroxypropyl cellulose, hydroxyethyl cellulose, or oxidized cellulose.In versions including chitin, the chitin may comprise chitosan (e.g.,deacetylated chitin) or chitosan salts.

Some versions of naturally based polymers that may be used to form anadhesive material may include a putty or wax-like material. Some suchversions may be non-absorbable and may be similar to a conventional bonewax. For instance, the material may comprise beeswax with one or more ofthe paraffin, petroleum jelly, isopropyl palmitate, sesame oil, carbolicacid; or any other conventional bone wax composition. Some otherversions of a putty or wax-like material that may be used to form anadhesive material for buttress body (102) may be absorbable orresorbable. For instance, some such versions may comprise HEMASORB®putty by Abyrx, Ink of Irvington, N.Y., water-soluble alkylenecopolymers (e.g., OSTENE by Baxter Healthcare Corporation of Deerfield,Ill.), glycerol, 1-lactide, glycolide, polyethylene glycol (PEG),polyethylene oxide (PEO), or polyolefin elastomer (POE). By way offurther example, the adhesive material may comprise polyethylene glycol(PEG) or a polyethylene glycol (PEG) copolymer with a molecular weightof less than 20,000 g/mol. Having the molecular weight in such a rangemay promote passage of the dissolved form of the adhesive through thekidneys. See, e.g., Webster et al., “PEGylated Proteins: Evaluation ofTheir Safety in the Absence of Definitive Metabolism Studies,” DrugMetabolism and Disposition, Vol. 35, No, 1, pp. 9-16 (2007), thedisclosure of which is incorporated by reference herein. As yet anothermerely illustrative example, the adhesive material may be constructed inaccordance with at least some of the teachings of U.S. Pat. No.2,642,375, entitled “Hemostatic Compositions,” issued Jun. 16, 1953, thedisclosure of which is incorporated by reference herein.

Some polymer adhesives, including but not limited to the putty orwax-like compositions referred to above, may include oxidizedregenerated cellulose (ORC), which is a hemostatic agent. For instance,a putty or wax-like composition may serve as a carrier for oxidizedregenerated cellulose (ORC). U.S. Patent Pub. No. 2012/0241493, entitled“Tissue Thickness Compensator Comprising Controlled Release andExpansion,” published Sep. 27, 2012, issued as U.S. Pat. No. 10,123,798on Nov. 13, 2018, the disclosure of which is incorporated by referenceherein, discusses various ways in which oxidized regenerated cellulose(ORC) may be incorporated into various compositions. It should beunderstood that such teachings of U.S. Patent Pub. No. 2012/0241493,issued as U.S. Pat. No. 10,123,798 on Nov. 13, 2018, may be readilyapplied herein in the context of incorporating oxidized regeneratedcellulose (ORC) into polymer adhesives, including but not limited to theputty or wax-like compositions referred to above.

The foregoing examples of natural based polymers are provided for merelyillustrative purposes. Other suitable examples will be apparent to thoseof ordinary skill in the art in view of the teachings herein. It shouldalso be understood that the foregoing examples of natural based polymersmay be readily incorporated into the various teachings and examplesprovided below. In other words, the foregoing examples of natural basedpolymers may be readily incorporated into any example herein that refersto an adhesive material.

C. Biologically Derived Extracellular Matrix with Infused ViscousAbsorbable Copolymer

In some instances, it may be desirable to provide a biologically derivedextracellular matrix (ECM) as buttress body (102) with an infusedviscous absorbable copolymer as an adhesive layer (104, 106) on upper orlower surfaces of buttress body (102). The below examples includevarious exemplary configurations through which a buttress assembly (100)may be formed by a combination of a biologically derived extracellularmatrix (ECM) with one or more infused viscous absorbable copolymeradhesive materials. In the present example, it is contemplated that theadhesive material comprises a natural based polymer such as thosereferred to herein. However, it should also be understood that syntheticbased polymers may be incorporated with the below teachings.

FIGS. 20-22 show an exemplary buttress assembly (900) that comprises abuttress body (902) and a plurality of discretely formed adhesiveregions (920, 922, 924, 926). Buttress body (902) may be configured andoperable just like buttress body (102) described above. Buttress body(902) of this particular example comprises a biologically derivedextracellular matrix (ECM) such as collagen. Adhesive regions (920, 922,924, 926) may comprise any of the various adhesive materials referred toherein. A first pair of proximal adhesive regions (920) are positionedat respective proximal corners of buttress body (902). A second pair oflateral adhesive region (922) are located near the longitudinal andlateral center of buttress body (902). A third pair of adhesive regions(924) are positioned at respective proximal corners of buttress body(902). A fourth pair of adhesive regions (926) extend longitudinallyalong the lateral mid-region of buttress body (902), such that adhesiveregions (926) are positioned to run alongside channel (62) of anvil (60)or channel (72) of staple cartridge (70). While adhesive regions (920,922, 924, 926) are provided in a particular pattern in this example, itshould be understood that buttress assembly (900) may instead haveadhesive regions in any other suitable pattern. It should also beunderstood that buttress assembly (900) may have a single layer ofadhesive material spanning along the full surface of buttress body(902), without having discretely formed adhesive regions. Other suitableconfigurations will be apparent to those of ordinary skill in the art inview of the teachings herein.

FIG. 21 shows how buttress body (902) provides a lattice defining aplurality of cells (908). Due to the presence of cells (908) and theporous nature of buttress body (902), some of the adhesive materialforming adhesive regions (920, 922, 924, 926) has entered some of thosecells (908), thereby partially infusing buttress body (902) with theadhesive material. In other words, buttress body (902) acts like asponge absorbing the adhesive material, allowing the adhesive materialto deform, surround, and essentially grab hold of the latticeconnections within buttress body (902).

In some instances, the adhesive material is initially applied tobuttress body (902) when the adhesive material is in a relatively highviscous form. Buttress assembly (900) is then heated to increase theviscosity of the adhesive material, causing the adhesive material toenter some of the cells (908) of buttress body (902). Buttress assembly(900) is then cooled or allowed to cool, causing the viscosity of theadhesive material to increase back to its previous state. Buttressassembly (900) may then be heated again as buttress assembly (900) isbeing applied to end effector (40) as described in greater detail below.In some other versions, the adhesive material already has a low enoughviscosity to enter cells (908) when the adhesive material is applied,without requiring the adhesive material to be heated. In other words,the adhesive material may wick into cells (908) of buttress body (902).In some such versions, a protective film (e.g., polytetrafluoroethylene(PTFE)) may be applied over the adhesive material to protect and/orcontain the adhesive material before buttress assembly (900) is appliedto end effector (900). Other suitable ways in which buttress assembly(900) may be formed and provided will be apparent to those of ordinaryskill in the art in view of the teachings herein.

FIG. 22 shows buttress assembly (900) being compressed between retainer(300) and anvil (60). As shown, this compression crushes the latticestructure of buttress body (902), collapsing cells (908) and therebydriving adhesive material out of buttress body (902) and into stapleforming pockets (64) (and/or into other surface features of underside(65)). This compression may be provided by closing anvil (60) againstbuttress assembly (900) and retainer (300) as described above. Whenanvil (60) is returned to the open position, the adhesive material instaple forming pockets (64) (and/or in other surface features ofunderside (65)) adheres buttress assembly (900) to underside (65), suchthat end effector (40) is loaded with buttress assembly (900) and isready for use. In some instances, retainer (300) and/or buttressassembly (900) may be heated just before buttress assembly (900) iscompressed between retainer (300) and anvil (60). Such heating mayincrease the viscosity of the adhesive material, thereby promotingmigration of the adhesive material into features of underside (65) andfurther thereby reducing the compression force required to urge theadhesive material into the features of underside (65).

FIG. 23 shows an exemplary alternative retainer (1000) that may be usedwith a buttress assembly such as buttress assembly (900). Retainer(1000) of this example comprises an upper side (1002), an underside(1004), a distally projecting tongue (1006), and a set of resilientlatches (1008). It should be understood that underside (1004), tongue(1006), and latches (1008) may be configured and operable just likeunderside (304), tongue (306), and latches (308) described above. Upperside (1002) of this example differs from upper side (302) in that upperside (1002) includes an array of upwardly protruding projections (1010)and a pair of longitudinally extending side rails (1012). Projections(1010) are configured to provide focused pressure to regions of buttressassembly (900) at regions corresponding to staple forming pockets (64)(and/or into other surface features of underside (65)), thereby furtherpromoting exit of the adhesive material from buttress body (902) intostaple forming pockets (64) (and/or into other surface features ofunderside (65)). Side rails (1012) are configured to contain adhesivematerial expelled from buttress body (902), preventing the adhesivematerial from spilling over the sides of retainer (1000). Other suitablestructural variations of retainer (1000) will be apparent to those ofordinary skill in the art in view of the teachings herein.

FIG. 24 shows another exemplary buttress assembly (1100) and retainer(1200). Buttress assembly (1100) of this example comprises a pair ofbuttress body sections (1102 a, 1102 b) that are joined by one or moretethers (1110) that span across a gap (1112) defined between buttressbody sections (1102 a, 1102 b). Gap (1112) extends longitudinally and issized to complement channels (62, 72) of anvil (60) and staple cartridge(70). Each buttress body section (1102 a, 1102 b) comprises abiologically derived extracellular matrix (ECM) such as collagen, suchthat each buttress body section (1102 a, 1102 b) has a lattice structuredefining a plurality of cells (not shown). Buttress assembly (1100)further comprises adhesive layer sections (1120 a, 1120 b) extendingalong respective body sections (1102 a, 1102 b). The adhesive materialforming adhesive layer sections (1120 a, 1120 b) may be formulated justlike the adhesive material forming adhesive regions (920, 922, 924, 926)described above. Adhesive layer sections (1102 a, 1102 b) each include aplurality of upwardly extending projections (1122). These projectionsare configured and positioned to correspond with staple forming pockets(64) on underside (65) of anvil (60).

Retainer (1200) of the present example has an upper surface (1202) thatincludes an upwardly projecting rib (1220) and a plurality of upwardlyextending projections (1222). Rib (1220) extends longitudinally and issized to complement channel (62) of anvil (60). As anvil (60) is drivento a closed position to compress buttress assembly (1100) against uppersurface (1202), rib (1220) may enter channel (62) and break tethers(1100). Rib (1220) may also ensure proper lateral alignment of retainer(1200) and buttress assembly (1100) with anvil (60). Various suitableforms that rib (1220) may take will be apparent to those of ordinaryskill in the art in view of the teachings herein. In some versions, rib(1220) is omitted. Projections (1222) are configured and positioned tocorrespond with projections (1122), staple forming pockets (64)underside (65) of anvil (60). Projections (1122, 1222) are configured tocooperate to provide focused pressure to regions of buttress assembly(1100) at regions corresponding to staple forming pockets (64) ofunderside (65) when anvil (60) is driven to a closed position againstbuttress assembly (1100) and retainer (1200), thereby further promotingexit of the adhesive material from buttress bodies (1102 a, 1102 b) intostaple forming pockets (64) of underside (65). Other suitable structuralvariations of buttress assembly (1100) and retainer (1200) will beapparent to those of ordinary skill in the art in view of the teachingsherein.

IV. Exemplary Combinations

The following examples relate to various non-exhaustive ways in whichthe teachings herein may be combined or applied. It should be understoodthat the following examples are not intended to restrict the coverage ofany claims that may be presented at any time in this application or insubsequent filings of this application. No disclaimer is intended. Thefollowing examples are being provided for nothing more than merelyillustrative purposes. It is contemplated that the various teachingsherein may be arranged and applied in numerous other ways. It is alsocontemplated that some variations may omit certain features referred toin the below examples. Therefore, none of the aspects or featuresreferred to below should be deemed critical unless otherwise explicitlyindicated as such at a later date by the inventors or by a successor ininterest to the inventors. If any claims are presented in thisapplication or in subsequent filings related to this application thatinclude additional features beyond those referred to below, thoseadditional features shall not be presumed to have been added for anyreason relating to patentability.

Example 1

A surgical stapler end effector, the end effector comprising: (a) astaple cartridge, wherein the staple cartridge comprises: (i) aplurality of staples, and (ii) a deck, wherein the staple cartridge isoperable to drive the staples through the deck; (b) an anvil, whereinthe anvil is movable from an open position toward the staple cartridgeto reach a closed position, wherein the anvil includes an undersidehaving staple forming surface configured to receive staples driventhrough the deck; and (c) a buttress assembly, wherein the buttressassembly comprises: (i) a buttress body, wherein the buttress bodydefines a plurality of cells, and (ii) an adhesive material, wherein theadhesive material is configured to removably secure the buttress body tothe deck of the staple cartridge or the underside of the anvil, whereinthe adhesive material comprises a polymer, wherein the polymer isbioabsorbable, wherein a first portion of the adhesive material islocated within cells of the plurality of cells, wherein a second portionof the adhesive material is located on the buttress body outside theplurality of cells.

Example 2

The surgical stapler end effector of Example 1 or any of the followingExamples, wherein the buttress body comprises an extracellular matrix.

Example 3

The surgical stapler end effector of Example 2, wherein theextracellular matrix comprises collagen.

Example 4

The surgical stapler end effector of any of the preceding Examples,wherein the second portion is provided in a plurality of discreteregions on the buttress body outside the plurality of cells.

Example 5

The surgical stapler end effector of Example 4, wherein the buttressbody defines a plurality of corners, wherein the discrete regionsinclude discrete regions located on at least two of the corners.

Example 6

The surgical stapler end effector of any of the preceding or followingExamples, wherein the buttress body is compressible.

Example 7

The surgical stapler end effector of Example 6, wherein the buttressbody is configured to drive some of the first portion of the adhesivematerial out of associated cells in response to compression of thebuttress body.

Example 8

The surgical stapler end effector of any of the preceding or followingExamples, further comprising a retainer, wherein the retainer isconfigured to removably hold the buttress assembly.

Example 9

The surgical stapler end effector of Example 8, wherein the retainerincludes a plurality of projections, wherein the projections areconfigured to provide focused pressure to discrete regions of thebuttress assembly.

Example 10

The surgical stapler end effector of Example 9, wherein the stapleforming surface of the anvil comprises a plurality of staple formingpockets.

Example 11

The surgical stapler end effector of Example 10, wherein the projectionsare configured and position to respond to the staple forming pockets tothereby provide focused pressure to discrete regions of the buttressassembly adjacent to the staple forming pockets.

Example 12

The surgical stapler end effector of Example 8, wherein the retainerincludes a pair of laterally positioned longitudinally extending rails,wherein the rails are configured and arranged to prevent leakage of theadhesive material at lateral outer edges of the deck of the staplecartridge or the underside of the anvil.

Example 13

The surgical stapler end effector of any of the preceding or followingExamples, wherein the buttress body comprises a pair of body portionslaterally spaced apart from each other by a longitudinally extendinggap.

Example 14

The surgical stapler end effector of Example 13, wherein the buttressassembly further comprises one or more tethers spanning across the gap,wherein the one or more tethers couple the body portions together.

Example 15

The surgical stapler end effector of Example 13, wherein staplecartridge and the anvil each define a respective channel, wherein thechannels are configured to receive a knife member, wherein the knifemember is configured to pass through the gap between the body portions.

Example 16

The surgical stapler end effector of Example 13, further comprising aretainer, wherein the retainer is configured to removably hold thebuttress assembly, wherein the retainer includes a rib configured to fitin the gap between the body portions.

Example 17

The surgical stapler end effector of any of the preceding or followingExamples, wherein the adhesive material comprises a hydrogel.

Example 18

The surgical stapler end effector of any of the preceding or followingExamples, wherein the adhesive material comprises one or morecompositions selected from the group consisting of alginate, hyaluronicacid, collagen, and polysaccharide.

Example 19

A surgical stapler end effector, the end effector comprising: (a) astaple cartridge, wherein the staple cartridge comprises: (i) aplurality of staples, and (ii) a deck, wherein the staple cartridge isoperable to drive the staples through the deck; (b) an anvil, whereinthe anvil is movable from an open position toward the staple cartridgeto reach a closed position, wherein the anvil includes an undersidehaving staple forming surface configured to receive staples driventhrough the deck; and (c) a buttress assembly, wherein the buttressassembly comprises: (i) a buttress body, wherein the buttress bodycomprises a collagen extracellular matrix, and (ii) an adhesivematerial, wherein the adhesive material is configured to removablysecure the buttress body to the deck of the staple cartridge or theunderside of the anvil, wherein the adhesive material comprises one ormore compositions selected from the group consisting of hydrogel,alginate, hyaluronic acid, collagen, and polysaccharide.

Example 20

A surgical stapler end effector, the end effector comprising: (a) astaple cartridge, wherein the staple cartridge comprises: (i) aplurality of staples, and (ii) a deck, wherein the staple cartridge isoperable to drive the staples through the deck; (b) an anvil, whereinthe anvil is movable from an open position toward the staple cartridgeto reach a closed position, wherein the anvil includes an undersidehaving staple forming surface configured to receive staples driventhrough the deck; (c) a buttress assembly, wherein the buttress assemblycomprises: (i) a buttress body, wherein the buttress body defines aplurality of cells, and (ii) an adhesive material, wherein the adhesivematerial is configured to removably secure the buttress body to the deckof the staple cartridge or the underside of the anvil, wherein at leastsome of the adhesive material is located in at least some of the cells;and (d) a retainer, wherein the retainer is configured to removably holdthe buttress assembly, wherein the retainer includes a plurality ofprojections, wherein the projections are configured to provide focusedpressure to discrete regions of the buttress assembly.

V. Miscellaneous

It should be understood that any one or more of the teachings,expressions, embodiments, examples, etc. described herein may becombined with any one or more of the other teachings, expressions,embodiments, examples, etc. that are described herein. Theabove-described teachings, expressions, embodiments, examples, etc.should therefore not be viewed in isolation relative to each other.Various suitable ways in which the teachings herein may be combined willbe readily apparent to those of ordinary skill in the art in view of theteachings herein. Such modifications and variations are intended to beincluded within the scope of the claims.

It should be appreciated that any patent, publication, or otherdisclosure material, in whole or in part, that is said to beincorporated by reference herein is incorporated herein only to theextent that the incorporated material does not conflict with existingdefinitions, statements, or other disclosure material set forth in thisdisclosure. As such, and to the extent necessary, the disclosure asexplicitly set forth herein supersedes any conflicting materialincorporated herein by reference. Any material, or portion thereof, thatis said to be incorporated by reference herein, but which conflicts withexisting definitions, statements, or other disclosure material set forthherein will only be incorporated to the extent that no conflict arisesbetween that incorporated material and the existing disclosure material.

Versions of the devices described above may have application inconventional medical treatments and procedures conducted by a medicalprofessional, as well as application in robotic-assisted medicaltreatments and procedures. By way of example only, various teachingsherein may be readily incorporated into a robotic surgical system suchas the DAVINCI™ system by Intuitive Surgical, Inc., of Sunnyvale, Calif.Similarly, those of ordinary skill in the art will recognize thatvarious teachings herein may be readily combined with various teachingsof any of the following: U.S. Pat. No. 5,792,135, entitled “ArticulatedSurgical Instrument For Performing Minimally Invasive Surgery WithEnhanced Dexterity and Sensitivity,” issued Aug. 11, 1998, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.5,817,084, entitled “Remote Center Positioning Device with FlexibleDrive,” issued Oct. 6, 1998, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 5,878,193, entitled “Automated EndoscopeSystem for Optimal Positioning,” issued Mar. 2, 1999, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 6,231,565,entitled “Robotic Arm DLUS for Performing Surgical Tasks,” issued May15, 2001, the disclosure of which is incorporated by reference herein;U.S. Pat. No. 6,783,524, entitled “Robotic Surgical Tool with UltrasoundCauterizing and Cutting Instrument,” issued Aug. 31, 2004, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.6,364,888, entitled “Alignment of Master and Slave in a MinimallyInvasive Surgical Apparatus,” issued Apr. 2, 2002, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 7,524,320,entitled “Mechanical Actuator Interface System for Robotic SurgicalTools,” issued Apr. 28, 2009, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 7,691,098, entitled “Platform Link WristMechanism,” issued Apr. 6, 2010, the disclosure of which is incorporatedby reference herein; U.S. Pat. No. 7,806,891, entitled “Repositioningand Reorientation of Master/Slave Relationship in Minimally InvasiveTelesurgery,” issued Oct. 5, 2010, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2013/0012957, entitled“Automated End Effector Component Reloading System for Use with aRobotic System, published Jan. 10, 2013, issued as U.S. Pat. No.8,844,789 on Sep. 30, 2014, the disclosure of which is incorporated byreference herein; U.S. Pub. No. 2012/0199630, entitled“Robotically-Controlled Surgical Instrument with Force-FeedbackCapabilities,” published Aug. 9, 2012, issued as U.S. Pat. No. 8,820,605on Sep. 2, 2014, the disclosure of which is incorporated by referenceherein; U.S. Pub. No. 2012/0132450, entitled “Shiftable Drive Interfacefor Robotically-Controlled Surgical Tool,” published May 31, 2012,issued as U.S. Pat. No. 8,616,431 on Dec. 31, 2013, the disclosure ofwhich is incorporated by reference herein; U.S. Pub. No. 2012/0199633,entitled “Surgical Stapling Instruments with Cam-Driven StapleDeployment Arrangements,” published Aug. 9, 2012, issued as U.S. Pat.No. 8,573,461 on Nov. 5, 2013, the disclosure of which is incorporatedby reference herein; U.S. Pub. No. 2012/0199631, entitled“Robotically-Controlled Motorized Surgical End Effector System withRotary Actuated Closure Systems Having Variable Actuation Speeds,”published Aug. 9, 2012, issued as U.S. Pat. No. 8,602,288 on Dec. 10,2013, the disclosure of which is incorporated by reference herein; U.S.Pub. No. 2012/0199632, entitled “Robotically-Controlled SurgicalInstrument with Selectively Articulatable End Effector,” published Aug.9, 2012, issued as U.S. Pat. No. 9,301,759 on Apr. 5, 2016, thedisclosure of which is incorporated by reference herein; U.S. Pub. No.2012/0203247, entitled “Robotically-Controlled Surgical End EffectorSystem,” published Aug. 9, 2012, issued as U.S. Pat. No. 8,783,541 onJul. 22, 2014, the disclosure of which is incorporated by referenceherein; U.S. Pub. No. 2012/0211546, entitled “Drive Interface forOperably Coupling a Manipulatable Surgical Tool to a Robot,” publishedAug. 23, 2012, issued as U.S. Pat. No. 8,479,969 on Jul. 9, 2013; U.S.Pub. No. 2012/0138660, entitled “Robotically-Controlled Cable-BasedSurgical End Effectors,” published Jun. 7, 2012, issued as U.S. Pat. No.8,800,838 on Aug. 12, 2014, the disclosure of which is incorporated byreference herein; and/or U.S. Pub. No. 2012/0205421, entitled“Robotically-Controlled Surgical End Effector System with RotaryActuated Closure Systems,” published Aug. 16, 2012, issued as U.S. Pat.No. 8,573,465 on Nov. 5, 2013, the disclosure of which is incorporatedby reference herein.

Versions of the devices described above may be designed to be disposedof after a single use, or they can be designed to be used multipletimes. Versions may, in either or both cases, be reconditioned for reuseafter at least one use. Reconditioning may include any combination ofthe steps of disassembly of the device, followed by cleaning orreplacement of particular pieces, and subsequent reassembly. Inparticular, some versions of the device may be disassembled, and anynumber of the particular pieces or parts of the device may beselectively replaced or removed in any combination. Upon cleaning and/orreplacement of particular parts, some versions of the device may bereassembled for subsequent use either at a reconditioning facility, orby a user immediately prior to a procedure. Those skilled in the artwill appreciate that reconditioning of a device may utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

By way of example only, versions described herein may be sterilizedbefore and/or after a procedure. In one sterilization technique, thedevice is placed in a closed and sealed container, such as a plastic orTYVEK bag. The container and device may then be placed in a field ofradiation that can penetrate the container, such as gamma radiation,x-rays, or high-energy electrons. The radiation may kill bacteria on thedevice and in the container. The sterilized device may then be stored inthe sterile container for later use. A device may also be sterilizedusing any other technique known in the art, including but not limited tobeta or gamma radiation, ethylene oxide, or steam.

Having shown and described various embodiments of the present invention,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, embodiments, geometrics, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention should be considered interms of the following claims and is understood not to be limited to thedetails of structure and operation shown and described in thespecification and drawings.

We claim:
 1. A surgical stapler end effector, the end effector comprising: (a) a staple cartridge, wherein the staple cartridge comprises: (i) a plurality of staples, and (ii) a deck, wherein the staple cartridge is operable to drive the staples through the deck; (b) a buttress assembly, wherein the buttress assembly comprises: (i) a buttress body, wherein the buttress body defines a plurality of cells, and (ii) an adhesive material comprising a polymer, wherein the polymer is bioabsorbable; and (c) a retainer, wherein the retainer is configured to removably hold the buttress assembly, wherein the retainer includes a plurality of projections on a surface of the retainer, wherein the projections are configured to provide focused pressure in a direction away from the surface of the retainer to discrete regions of the buttress assembly.
 2. The surgical stapler end effector of claim 1, wherein the buttress body comprises an extracellular matrix.
 3. The surgical stapler end effector of claim 2, wherein the extracellular matrix comprises collagen.
 4. The surgical stapler end effector of claim 1, wherein a first portion of the adhesive material is located within cells of the plurality of cells, wherein a second portion of the adhesive material is located on the buttress body outside the plurality of cells and wherein the second portion of the adhesive material is configured to removably secure the buttress body to the deck of the staple cartridge.
 5. The surgical stapler end effector of claim 4, wherein the second portion is provided in a plurality of discrete regions on the buttress body outside the plurality of cells.
 6. The surgical stapler end effector of claim 4, wherein the buttress body defines a plurality of corners, wherein the discrete regions include discrete regions located on at least two of the corners.
 7. The surgical stapler end effector of claim 4, wherein the buttress body is compressible.
 8. The surgical stapler end effector of claim 7, wherein the buttress body is configured to drive some of the first portion of the adhesive material out of associated cells in response to compression of the buttress body.
 9. The surgical stapler end effector of claim 1, further comprising an anvil, wherein the anvil is movable from an open position toward the staple cartridge to reach a closed position, wherein the anvil includes an underside having a staple forming surface configured to receive staples driven through the deck.
 10. The surgical stapler end effector of claim 9, wherein the staple forming surface of the anvil comprises a plurality of staple forming pockets.
 11. The surgical stapler end effector of claim 10, wherein the plurality of projections is configured and positioned to respond to the staple forming pockets to thereby provide focused pressure to discrete regions of the buttress assembly adjacent to the staple forming pockets.
 12. The surgical stapler end effector of claim 9, wherein the retainer includes a pair of laterally positioned longitudinally extending rails, wherein the rails are configured and arranged to prevent leakage of the adhesive material at lateral outer edges of the deck of the staple cartridge or the underside of the anvil.
 13. The surgical stapler end effector of claim 9, wherein the buttress body comprises a pair of body portions laterally spaced apart from each other by a longitudinally extending gap.
 14. The surgical stapler end effector of claim 13, wherein the buttress assembly further comprises one or more tethers spanning across the gap, wherein the one or more tethers couple the body portions together.
 15. The surgical stapler end effector of claim 13, wherein the staple cartridge and the anvil each define a respective channel, wherein the channels are configured to receive a knife member, wherein the knife member is configured to pass through the gap between the body portions.
 16. The surgical stapler end effector of claim 13, wherein the retainer is configured to removably hold the buttress assembly, wherein the retainer includes a rib configured to fit in the gap between the body portions.
 17. The surgical stapler end effector of claim 1, wherein the adhesive material comprises a hydrogel.
 18. The surgical stapler end effector of claim 1, wherein the adhesive material comprises one or more compositions selected from the group consisting of alginate, hyaluronic acid, collagen, and polysaccharide.
 19. A surgical stapler end effector, the end effector comprising: (a) a staple cartridge, wherein the staple cartridge comprises: (i) a plurality of staples, and (ii) a deck, wherein the staple cartridge is operable to drive the staples through the deck; (b) a buttress assembly, wherein the buttress assembly comprises: (i) a buttress body, wherein the buttress body comprises a collagen extracellular matrix; and (c) a retainer, wherein the retainer is configured to removably hold the buttress assembly, wherein the retainer includes a plurality of projections on a surface of the retainer, wherein the projections are configured to provide focused pressure in a direction away from the surface of the retainer to discrete regions of the buttress assembly.
 20. A surgical stapler end effector, the end effector comprising: (a) a staple cartridge, wherein the staple cartridge comprises: (i) a plurality of staples, and (ii) a deck, wherein the staple cartridge is operable to drive the staples through the deck; (b) an anvil, wherein the anvil is movable from an open position toward the staple cartridge to reach a closed position, wherein the anvil includes an underside having staple forming surface configured to receive staples driven through the deck; (c) a buttress assembly, wherein the buttress assembly comprises: (i) a buttress body, wherein the buttress body defines a plurality of cells, and (ii) an adhesive material, wherein the adhesive material is configured to removably secure the buttress body to the deck of the staple cartridge or the underside of the anvil, wherein at least some of the adhesive material is located in at least some of the cells; and (d) a retainer, wherein the retainer is configured to removably hold the buttress assembly, wherein the retainer includes a plurality of projections on a surface of the retainer, wherein the projections are configured to provide focused pressure in a direction away from the surface of the retainer to discrete regions of the buttress assembly. 